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News & Events

NEXT CLUB MEETING

20 April 2020


DATE TODAY

5 February 2012

Membership Form - New Members

Please fill in the form below to become a member of The Charger Club of Victoria

NEW MEMBERSHIP APPLICATION

NAME SURNAME
DISPLAY NAME / NICK NAME
DATE OF BIRTH

HOME ADDRESS

STREET
SUBURB
POST CODE STATE

POSTAL ADDRESS

PO BOX
STREET
SUBURB
POST CODE STATE

PHONE

MOBILE/ LANDLINE MOBILE/ LANDLINE

EMAIL

CONTACT EMAIL CONFIRM EMAIL

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

MAKE YEAR
MODEL ENGINE
OTHER COMMENTS COLOUR
ADD CHRYSLER NO CHRYSLER CURRENTLY

MEMBERSHIP TYPE