Membership Form

 

WAORRA Online Membership Form

First Name(required)

Last Name(required)

Address(required)

Suburb(required)

State(required) Western Australia Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria

Postcode(required)

Email Address(required)

Mobile Phone(required)

Home Phone

Are you a...(required) Driver Navigator Pit Crew Official Spectator

Race Car Number(required)

Race Team Name(required)

Membership type(required) Individual $50 Family $100 Single Event $20 Committee/Life Member $0

Payment(required) EFT - BSB: 036-078 Acct: 123224 Name: WA Off Road Racing Association Cheque - made payable to WA Off Road Racing Association Cash at the next event

Membership card(required) Please send to me by post Please bring it to the next event

Additional Family Member #1

Email Address

Are you a... Driver Navigator Pit Crew Official Spectator

Race Car Number

Race Team Name

Additional Family Member #2

Email Address

Are you a... Driver Navigator Pit Crew Official Spectator

Race Car Number

Race Team Name

Additional Family Member #3

Email Address

Are you a... Driver Navigator Pit Crew Official Spectator

Race Car Number

Race Team Name

Additional Family Member #4

Email Address

Are you a... Driver Navigator Pit Crew Official Spectator

Race Car Number

Race Team Name

I authorise WAORRA to disclose my/my family's details to other clubs and associations in order to receive event information(required) Yes

No

Submit