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

Name of Applicant - 

Mr              Mrs               Ms            Miss 

Address

Telephone -   Home                                  Work                            Mobile

                    Email:______________________________________________
                    Newsletter will be emailed

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  $81             Junior $45               Family 1  $85            6 month - $45 (new only)  
 

Family 2  $160                Associate  $40                   Single Event membership  $15
 

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 - $
 

Junior members who pay $45 membership will have their first motorkhana free