SOUTH EASTERN AUTOMOBILE CLUB OF SA INC
PO BOX 1551, Mt GAMBIER 5290 - www.seacsa.com - PH/FAX - (08) 8723 4011
APPLICATION FOR MEMBERSHIP  2009

Name of Applicant - 

Mr              Mrs               Ms            Miss 

Address

Telephone -   Home                                  Work                            Mobile

                   Email

Date of Birth –                                    Occupation –

Vehicles -

Please list Family Members Below

Name                                                        Date of Birth –

Name                                                        Date of Birth –

Name                                                        Date of Birth –
 

Type of Membership                           Membership No –

Full  $77                         Junior $44                           Family 1  $82      

Family 2  $148                Associate  $37                   Weekend/Event membership  $12
 

CAMS Officials Grading/s

Member 1-                                           Member 2 -

OFFICE USE ONLY

Membership Type -                                     Number -
 

           Receipt No. -                                   CAMS Level  and Licence No.
 

Date Issued                                                Amount Paid - $