Senior Membership

2023 / 2024 MEMBERSHIP SEASON

Membership valid for financial year only (1.07.23 – 30.06.24)

Price:

$55 for access until June 30, 2024

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Date of Birth:* Date of Birth is Required

Phone:* Phone is Required

Email Address:* Email Address is Required

Race Division: Race Division is not valid

Car number (if already allocated or Car you are involved with):: Car number (if already allocated or Car you are involved with): is not valid

License Class: License Class is not valid

Transponder number: Transponder number is not valid

Emergency Name:* Emergency Name is Required

Emergency Contact:* Emergency Contact is Required

I do hereby declare to accept the committee’s decision as to my acceptance into the Gladstone Auto Club Inc. for which I have applied. In the case of not being accepted as a full member, I reserve the right to reapply in no less than 3 months from this date. I also undertake to accept the Committee’s right to terminate my membership should I fail to uphold the club rules and articles in its constitution.*

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Description	Amount
Adult membership - $55 – Payment	$55.00
Total	$55.00

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Senior Membership

2023 / 2024 MEMBERSHIP SEASON

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