Star_Torque_Autumn_2017

Membership form Form
Mercedes-Benz Club of NSW
Incorporated with limited liability ABN 43 684 976 470
ONLINE Membership Application & Renewal
E-form go to: www.mbcnsw.org.au
Membership Application & Renewal form
Please send completed form
with any cheques to:
Membership Secretary
Mercedes-Benz Club
of NSW Inc.
PO BOX 6082
Baulkham Hills, NSW, 2153.
See over for fees & opons
>
Membership details: New Member Renewal & membership number:
Member:
Title First name Last name
Number
Street address
Address:
Suburb/town State Postcode Country
Phone:
Home
Mobile
Additional
Email:
Primary
Secondary
Associate:
Title First name Last name
Relationship (optional)
Occupation:
Member (optional)
Associate (optional)
Compliance with Club constitution
I/we agree to comply with all Club rules under the
current constitution. I/we understand that failure to
comply may lead to membership being cancelled.
Member signature:
Associate signature:
Date:
Date:
/ /
/ /
Australian Mercedes-Benz Club discount
If you hold membership of another Mercedes-Benz Club in Australia, there is no joing fee ($25.00) for the Mercedes-
Benz Club of NSW, by proving this to us with a photocopy of your membership card lodged with this form.
Details of your Mercedes-Benz Vehicle(s).
Year Model Reg Body colour Interior colour
Year Model Reg Body colour Interior colour
Year Model Reg Body colour Interior colour
Year Model Reg Body colour Interior colour
Year Model Reg Body colour Interior colour
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