SYDNEY-CENTRAL COAST AVAN GROUP
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Sydney - Central Coast A'Van Group
Registration Form to Join SCCAVAn
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Name
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Partner's Name
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First
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Email
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Phone Number
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Mobile Phone Number
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Fax Number
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Address
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Line 1
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State
Zip Code
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Type of Van
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Cruiseliner
Aliner
Sportliner
Weekender
Pop Top
Hard Top
Other Please identify van.
Model
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1
1D
2B
3
3C
4A
5
CL
SB
402 Gabrielle
HT 563 Jack
Aspire 499 HT
Other
Other Type of Van
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Post (B & W)
Please make your cheque payable to:
Sydney-Central Coast A Van Group Inc. and post with your cheque/money order for $50 to the Treasurer* by 30th June, 2017
OR
Direct Deposits to:
BSB 032 285
Account Number: 485721
(Sydney-Central Coast A Van Group Inc.)Untitled
Please use your name as the Account Name.
Please make your cheque payable to Sydney-Central Coast A Van Group Inc. and print & post this form with your cheque/money order for $50 to the Treasurer* by 30th June, 2017 OR If Direct Deposit is used you MUST still fill in, save, and email a copy to the Treasurer* email: dave.di67@bigpond.com Direct Deposits to BSB 032 285 Account Number: 485721 (Sydney-Central Coast A Van Group Inc.)Untitled
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Please make your cheque payable to Sydney-Central Coast A Van Group Inc. and print & post this form with your cheque/money order for $50 to the Treasurer* by 30th June, 2017 OR If Direct Deposit is used you MUST still fill in, save, and email a copy to the Treasurer* email: dave.di67@bigpond.com Direct Deposits to BSB 032 285 Account Number: 485721 (Sydney-Central Coast A Van Group Inc.)Untitled
* The Treasurer, S-CC A VAN Group Inc, Mr. David Luttrell, 8 Benjamin Close,Tumbi Umbi, NSW 2261 I have read and understood the information. Applicant KEY IN NAME or SIGN ## KEY IN or PRINT IN BOX ## Signed Date Spouse/Partner KEY IN NAME or SIGN ## KEY IN or PRINT IN BOX ## Signed Date ## BY E-MAILING THIS APPLICATION YOU ACKNOWLEDGE THAT A SIGNATURE HAS NOT BEEN GIVEN AND THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT IN ALL RESPECTS The Sydney-Central Coast A'Van 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.
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