Victorian Renewal Form

You must enter your membership number (printed on your membership card) and tick the appropriate checkbox to indicate the method of payment.

Please fill in the details of your motorcycles that are registered through the CIMAA club permit scheme. It is our legal requirement to maintain a database of registered vehicles. You can list multiple registrations in the form field as:

Make    Model      Year of Manufacture       Registration Number        Expiry Date
Make    Model      Year of Manufacture       Registration Number        Expiry Date

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

You may leave the other fields blank if your information has not changed from last year.

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.

Membership Number:

First Name:


Last Name:

Street:

City:

State:

Post Code:

Home Phone:

Work Phone:

Mobile:

Email Address:

Eligible Motorcycles Currently Owned (not registered by CIMAA):

Motorcycles currently registered by CIMAA (Make/Model/Year/Registration/Expiry)

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Payment by:  EFT Cheque/Money Order

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