Membership Renewal Form

Name *

First

Last

Date of Birth dd/mm/yyyy *

dd /mm / yyyy

Phone Number *

Additional Family Members and DOB

House Number and Street Address *

Suburb *

State *

Postcode *

Home Phone

Email *

Vehicle Type *

Morris 850
Deluxe
Mini K
Morris Cooper / Cooper S
Mini Clubman (All Types)
Moke
MINI Cooper
MINI Cooper S
JCW Cooper S
MINI Clubman & S
MINI Clubman JCW
GP1,2 or 3
Other

Colour *

Year *

Other Vehicles Owned

Payment Option.Please note: After submitting this form you will need to return to the Membership page to make your PayPal payment *

PayPal
Direct Debit - Please include your surname in the description
Cheque
Cash at meeting (Please don't send cash in the post)
Other

Please advise other payment method

Thanks for renewing your membership with the Mini Car Club of NSW. If you are paying with PayPal please return to the Membership Renewal page and complete the payment or make your payment via Direct Debit. After payment has been made your new membership card will be mailed out in the next few days.

Name