Honda Riders Club of Australia - Application for Membership

* Denotes Required Field

Post:

The Honda Riders Club
106 Morrison Road
Western Australia, 6057

 

 

Phone:
Fax:
Country Call:

(08) 9274 3555
(08) 9274 1978
1800 466 321
 
I hearby apply for membership to The Honda Riders Club of Australia*
   

Title:
if other: *

Surname:
*

First Name:
*

Street/PO Address:

*

State:
*

Post Code:
*

Phone (H):

*

Phone (W):
*

Country:
*

Email:
*

Date of Birth
*

Riding Experience Years:
*

License details at this date:
Full Probationary
Learner Recreational
Competition None
 

Honda motorcycle details:

Model:

Year:

Other motorcycles you own by brand/model:


Other motorcycle clubs of which you are a member:


Your Honda motorcycle Dealer:

Is this a renewal?

Yes No

Membership No:

Are you interested in Honda organised rallies? Yes No

Are you interested in attending race meetings? Yes No

Payment Details:

New Memberships: $33.00 incl GST

Renewals: $27.50 incl GST

Credit Card:

Card Holders Name:

Card Number:

Expiry Date:

* Please tick to show you have read the 'terms and conditions' below
   

Thankyou for your submission to Join Honda Riders Club.

Please allow 21 days from the date of registration for processing and mailing of your membership details.