MEMBERSHIP APPLICATION
Print this form and mail to
Z Club W.A PO BOX 351 Gosnells W.A
Name :___________________________________________________________
Address:__________________________________________________________
Telephone Number_________________________________________
Emergency contact person:________________________________
Telephone Number:___________________
Type of Bike:____________________________________________
Renewal YES NO
Social Member Nominated by:______________________________________
Seconded by:_____________________________________________________
Do you object having your Phone number being available to other
club members YES NO
Applicants signature :_______________________
DATE: ......../......./.......
Club Secretary sig:_______________________
Committee member sig:_____________________
Membership fees are due on receipt of application
Fees are $36.00 per annum
Please Make Cheque, Money order Payable to :Kawasaki Z Owners Club W.A
Po Box 351 Gosnells W.A 6110
Address:__________________________________________________________
Telephone Number_________________________________________
Emergency contact person:________________________________
Telephone Number:___________________
Type of Bike:____________________________________________
Renewal YES NO
Social Member Nominated by:______________________________________
Seconded by:_____________________________________________________
Do you object having your Phone number being available to other
club members YES NO
Applicants signature :_______________________
DATE: ......../......./.......
Club Secretary sig:_______________________
Committee member sig:_____________________
Fees are $36.00 per annum
Please Make Cheque, Money order Payable to :Kawasaki Z Owners Club W.A
Po Box 351 Gosnells W.A 6110