Victorian Application Form

The annual membership fee is $30. Membership is from 1st July to 30th June and not from the date you join. Payment methods will be presented to you on completion of this form.

Please use your postal address to allow delivery of the Membership Card. If you use a Post Office Box number enter it in the “Street” field.

First Name:


Last Name:

House # and street:

City:

State:

Post Code:

Home Phone:

Work Phone:

Mobile:

Email Address:

Eligible Motorcycles Currently Owned:

(Make model year registration number)

Contact me by email or post:

Payment by:  EFT Cheque/Money Order

On successful admission as a member to CIMAA, I agree to be bound by its rules.

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