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Membership form<br />
Mercedes-Benz Club of NSW<br />
Incorporated with limited liability ABN 43 684 976 470<br />
Membership Application<br />
and Renewal form<br />
Membership details: New Member Renewal & membership number:<br />
Please send completed form<br />
with any cheques to:<br />
Membership Secretary<br />
Mercedes-Benz Club<br />
of NSW Inc.<br />
PO Box 155,<br />
St Ives, NSW, 2075.<br />
See over for fees & opons<br />
><br />
Member:<br />
Title First name Last name<br />
Number<br />
Street address<br />
Address:<br />
Suburb/town State Postcode Country<br />
Phone:<br />
Home<br />
Mobile<br />
Additional<br />
Email:<br />
Primary<br />
Secondary<br />
Associate:<br />
Title First name Last name<br />
Relationship (optional)<br />
Occupation:<br />
Member (optional)<br />
Associate (optional)<br />
Compliance with Club constitution<br />
I/we agree to comply with all Club rules under the<br />
current constitution. I/we understand that failure to<br />
comply may lead to membership being cancelled.<br />
Member signature:<br />
Associate signature:<br />
Date:<br />
Date:<br />
/ /<br />
/ /<br />
Australian Mercedes-Benz Club discount<br />
If you hold membership of another Mercedes-Benz Club in Australia, there is no joing fee ($50.00) for the Mercedes-<br />
Benz Club of NSW, by proving this to us with a photocopy of your membership card lodged with this form.<br />
Details of your Mercedes-Benz Vehicle(s).<br />
Year Model Reg Body colour Interior colour<br />
Year Model Reg Body colour Interior colour<br />
Year Model Reg Body colour Interior colour<br />
Year Model Reg Body colour Interior colour<br />
Year Model Reg Body colour Interior colour<br />
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