News & Events

NEXT CLUB MEETING

NEW MEMBERSHIP APPLICATION
NAME	SURNAME

DISPLAY NAME / NICK NAME

DATE OF BIRTH


HOME ADDRESS
STREET

SUBURB

POST CODE	STATE

POSTAL ADDRESS
	PO BOX
SELECT IF THE SAME AS ABOVE
STREET

SUBURB

POST CODE	STATE

PHONE
MOBILE/ LANDLINE	MOBILE/ LANDLINE

EMAIL
CONTACT EMAIL	CONFIRM EMAIL

The email entered will be visible to other members in the members area so that they can contact you. Please select this box if you don't want to be contacted.

MY CHRYSLERS [Please list the Chryslers that you CURRENTLY own]

MAKE	YEAR

MODEL	ENGINE

OTHER COMMENTS	COLOUR

ADD CHRYSLER NO CHRYSLER CURRENTLY

MEMBERSHIP TYPE

I AGREE TO ABIDE BY THE RULES & REGULATIONS OF THE CHARGER CLUB OF VICTORIA INC.