Application | Sydney District 4x4 Club

Applicant's Details

PRIMARY FAMILY NAME

PRIMARY GIVEN NAME

Preferred Name (if different to the above. eg for name badge)

Preferred Name

Email *

Password *

Mobile

Street Address *

Apartment, suite, etc

City *

ZIP / Postal Code *

SECONDARY FAMILY NAME

SECONDARY GIVEN NAME

Preferred Name (if different to the above. eg for name badge)

Preferred Name

Email

Mobile

Do you have children? (optional)

YesNo

Number of Children

Names of Children

NOTE: Communication with our members is via e-mail, Facebook and our website only.

Vehicle's Details

VEHICLE MAKE

VEHICLE MODEL

REGO.

Is your vehicle currently registered?

YesNo

Do you have a current drivers license?

YesNo

NOTE: Only one vehicle per membership per event

What are you looking for?

Where did you find out about our Club?

Why do you want to join a 4WD Club?

Have you been a member of a 4WD club before?

YesNo

If yes, which Club?

What sort of trips are you interested in attending (e.g. day, weekend, week, feel free to indicate areas you would like to visit on a trip):

First Aid

Does the primary applicant have a current First Aid Certificate?

YesNo

If yes, when does it expire?

Does the secondary applicant have a current First Aid Certificate?

YesNo

If yes, when does it expire?

Do you wish the Club to be aware of any allergies or medical conditions within your family?

YesNo

If yes, please give details:

Allergies/Condition

Any medical information provided on this form is only made available to Committee Members and Driver Trainers

Any condition that may affect you on a trip should be reported to the Trip Leader / Driver Trainer prior to the commencement of the event

Other Information

Are you interested in learning to lead trips?

YesNo

Would you like more information on learning to lead trips?

YesNo

What training would you like to attend or be made available?

Do you have any other qualifications / skills that you could utilise within the Club?

What is your Occupation? (optional)

Do you know any Members of the club?

YesNo

Please list the Name/Names.

Comments / Suggestions

Do you have any other comments or suggestions?

Agreement

Please write your full name.

Full Name

Date

Payment must accompany application. You will be redirected to Membership Payments after submitting your application