Membership

MEMBERSHIP FORM

First Name*

Surname*

Your address*

Your email*

Your mobile*

Emergency Contact Name

Emergency Contact Number

Relationship

Please select:
FullPillion/PartnerSponsorship

Please note: one form per member is required

In submitting this application, I confirm that:
I agree to be bound by the rules of the association of the Vespa Club of Townsville Inc.
I am certifying that I am licensed to ride a motorcycle in the state of Queensland, and the Vespa I ride to club events is registered, roadworthy and has at least Third Party Property Insurance.

Vespa Model*

Vespa Registration*

I agree with the above text

Once you submit this form, we will be in touch regarding payment.

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