SOUTH AUSTRALIAN CLUB MEMBERSHIP APPLICATION FORM
Please printout form, fill it in and post it to the address shown below:  

NAME: FIRST

ADRESS:
Street
City/Suburb

State

Post/Zip Code

Country (If outside Australia)



SURNAME

TELEPHONE:
(home)
(fax)
(business)
(mobile)
email

 

PLEASE NOTE: THIS IS FOR

MODEL OF BOLWELL(s):
mk 1V
mk V
mk V1
mkV11
Nagari
Ikara

VEHICLE ORIGIN:
Coupe Sports
Factory Fibrecar Replica

Registration No:
Serial or Chassis No:
Colour:
SPECIFICATIONS:
Chassis type:
Engine:
Gearbox: Differential:
Brakes: Wheels:
Other details:

CONDITION:
Going
Static Minor repairs
Major repairs

OTHER VEHICLES IN YOUR GARAGE:


 


 



 





SOUTH AUSTRALIA MEMBERHSIP ONLY
TYPE OF MEMBERSHIP:

Full/Couple $40.00 per year
Half year membership (after 1st Jan) $20.00
New membership fee (paid only on joining) $10.00
Slipstream only A$20.00
per year

Your cheques should be made out to The Bolwell Car Club of South Australia:
Your membership will be activated once your payment has
been received. The postal address is:
THE SECRETARY BOLWELL CAR CLUB OF AUSTRALIA(SA) BRANCH
PO Box 2226
KENT TOWN Sth. Aust. 5071
AUSTRALIA

 

 

 

 

 

 

 

 

 

 

 


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