NSW UTE CLUB Membership Application
FULL Membership FULL MEMBERSHIP MEMBER NUMBER_____________________
Name:
Date of birth:	Mobile:	Phone:
Current address:
Post Code:	Forum Name:	License No:
Ute Model:	Registration No:	Ute Colour:
associated membership Spouse/Family member Information MEMBER Number_______________________
Name:
Date of birth:	Mobile:	Phone:
Current address:
Post Code:	Forum Name:	License No:
PROSPECTIVE/honorary membership PROSPECTIVE/honorary member Information MEMBER Number_______________________
Name:
Date of birth:	Mobile:	Phone:
Current address:
Post Code:	Forum Name:	License No:
Ute Model:	Registration No:	Ute Colour:
Emergency Contact
Name of a relative not residing with you:
Mobile:	Phone No:
Relationship:
I have read the conditions of NSW UTE CLUB membership and agree to abide by the Constitution & By-Laws. I understand the club committee reserves the right to take action they consider appropriate should the constitution be breached.
Signature of applicant 1:		Date:
Signature of applicant 2:		Date:
Please remind me of club events via SMS		YES / NO