Test – Australian Motorhoming Lions Club

Applicants Name (required) *

Date of Birth (required) *

Email Address (required) *

Phone Number (required) *

Home Address (required) *

Postal Address

Occupation (required) *

Special Interests (required) *

Story of Applicants History (required) *

Partners Name

Partners First Name

Partners Last Name

Transfer Member? Previous Club

Club Number

FamilyStudentYoung AdultLeoFormer Leo

I agree to pay my Membership fee of (required)Single $90.00Couple $170and once only joining fee of (required)$40.00

Motorhome Description (required)*

State Motorhome Registered (required)*

Motorhome rego Number (required)*

File may be attached:

Sponsors Name (required)*

* Required

Office use only

New member added to AMLC website

New member added to facebook page

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