Classic Italian Motorcycle Association of Australia (Vic) Inc.
Membership Application Form

Please fill out the following form and click on the PRINT button.
Sign it, place in an envelope along with a cheque for $30 and send it off to the address below

    First Name 
    Last Name
Address 
    Street  
    City    
    State      Postcode

Contact Details 
    Phone Home   
    Phone Bus.   
    Mobile       
    Email        
    Would you like notice of events sent by email
Motorcycles Currently Owned

Reasons for joining

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

Signature of Applicant: ………………………………………………………………………
Date:……………………
Please send this form along with a cheque for $30 payable to
The Classic Italian Motorcycle Association of Australia (Vic) Inc. to: 

        Trevor Lock
        The Secretary
        PO Box 565
        Glen Waverley VIC 3150

        Call Trevor Lock on 0405 274308 or email lock@alphalink.com.au for all membership enquires