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| QRACING MEMBERSHIP APPLICATION FORM |
| ACN 003 980 872 |
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| Name: |
(print full names) |
| Street Address: |
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| Suburb / City: |
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| State: |
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PostCode:
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| Phone (home): |
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Senior Card No: |
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(if applicable) |
| Date of Birth: |
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| (for office use only) |
| Proposed by Member: |
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| Seconded by Member: |
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| Approved: |
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Date: |
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| Full membership |
$60.00 |
| Senior membership |
$30.00 |
| Until 30th June 2009 |
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| Send to: |
Queanbeyan Racing Club
42 McCrae St
Queanbeyan NSW
2620 |
| Phone: |
(02) 6299 2398 |
| Fax: |
(02) 6299 2589 |
| Email: |
qracing@ozemail.com.au
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