New Rego Page 3

Sydney-central coast a'van group inc

ABN 62 842 468 219

ReNEWAL Form

Membership of the Sydney-Central Coast AVan Group inc is open to individuals who own an AVan Camper, Caravan, or recreational vehicle manufactured by AVan Campers and Caravans Pty Ltd. including Golf and Knaus products.
By completing this form and submitting payment by June 30, I/we agree to be bound by the Clubs Constitution together with such operating procedures which apply from time to time.

* Indicates required field

Member's Name *

First

Last

Partner's Name *

First

Last

Email *

Partner's Email *

Phone Number *

Mobile Phone Number *

Partner's Mobile Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Type of Van *

Model *

Other Type of Van or Model *

Please indicate the Bank Ref. Number for payment made *

Date Payment was made *

Payment and forms DUE DATE: 30th June

Direct Deposits $40 to:
BSB 032 285 Account No: 485721
Account Name: Sydney-Central Coast A Van Group Inc.
Please use your name as the Reference

The Sydney-Central Coast Avan Group Inc does not accept any liability that may occur involving a member enroute to, from, or during, any gathering or club function. Participants choose to take part in any club activities at their own risk.

SUBMIT