A.W.R.A. Membership Change/Renewal

(* Denotes mandatory field)

*Member Number:		*Member Name:						Nickname:
Address	*No / Street:							Phone No:
	*Town/City:							Home:
	*Post Code:							Work:
	*State/Country:							Mobile:
Email address	*Primary
	Secondary

Associate Number:		Associate Name:						Nickname:
Address (if different)	No / Street:							Phone No:
	Town/City:							Home:
	Post Code:							Work:
	State/Country:							Mobile:
Email address

Bike Details:	*Make:				2nd Bike Details:			Make:
	*Model:							Model:
	*Year:							Year:
	*Colour:							Colour:
	*Rego No:							Rego No:

Change / Confirmation of personal details:
If paying fees:	Membership Renewal Fees 2010:	Ordinary: Associate: Auxiliary:	$20.00 $10.00 $10.00	Select payment method		Electronic Funds Transfer; (Preferred)	Deposit to: Australian Wing Riders Assoc BSB: 638-070 Account No: 8970955 To A/c details: Fees Member No & Surname EFT Receipt No:
						Cheque or money order	Post to: Australian Wing Riders Assoc. (Qld) Inc PO Box 1321, BURPENGARY DC, Qld 4505.

Publication of Membership Information The details supplied above will be entered onto a membership list. A copy of this list is published on the Internet in a secure area accessible exclusively to AWRA Members via password. However, internet security cannot be guaranteed, so if you do not wish your details to be published in this way, tick this box. # # Please note that ticking this box will make it difficult for other members to contact you.

Submission of this form certifies that payment as described above has also be submitted.

Australian Wing Riders Association (Qld) Inc