MB Classic Car Club Inc.

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Application Form

Membership

To apply for MBCCC Membership, please EITHER call:

The Secretary
MB Classic Car Club Inc.

on phone no. 0404 952 125

and request an application form

OR, to apply online:

complete the form below and click the "Send" button which will transmit your application to MBCCC, and then return you to our Home Page. We will contact you when your application has been reviewed, and let you know how to complete the process of becoming a member.

MEMBERSHIP APPLICATION FORM

Applicant's Name*:

Partner's Name:

Home Address*:

Phone (home)*:

Phone (work):

Phone (mobile):

E-mail address*:

Member Category - select one*:
Retired, single $25 per annum
Retired, couple $30 per annum
Working, single $35 per annum
Working, couple $40 per annum

Your Mercedes-Benz Cars (model, year, colour, & reg. no.)*:

Enter the letters shown into the following image*:

Applicant's Agreement:

I apply for membership of the MB Classic Car Club Incorporated, and if my application is successful, I agree to abide by the Club's Rules, which are the Model Rules as published by the NSW Office of Fair Trading. I understand that MBCCC Inc. will not provide my details to third parties, and will use my details only for maintaining its membership records and for contacting me in relation to Club matters.

I agree I do not agree