Name..............................................................................................Member No: .......................
Address...........................................................................................................................................
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Telephone.......................................................................................................................................
E-mail..............................................................................................................................................
By ticking box I do not wish to be informed by email of club related information. [ ]
Club Permit Vehicle Register
Permit No.
Make & Model.
Expires.
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Other Bikes Owned:.....................................................................................................................
Motorcycling
Interests: (Please indicate) Touring
Social
Off-Road
Restoration
Competition
Other.......................................................................................................
Membership Fees:
Membership
Victoria
Other
States
International
Single
$50.00
" "
$AUD50.00
Payment enclosed:..................................
Card No: __|__| __|
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Expiry Date
Type:
Visa
Master Bankcard
I the undersigned agree to abide by the Constitution & Rules of the BSA Motorcycle Owners Association Inc.
Signature……………………………………………………….Date__|__|
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BSA Motorcycle Owners Assoc’n Inc, P.O.
Box
8100
,Northland Centre,
Vic, 3072. |