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BH Speedway Club Membership 2019/20
1st July 2019 to 30th June 2020
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Email
*
Your email
BH Speedway Club
Name of members & MA or Speedway Aust Lic #
*
Your answer
Address & Mobile Number
*
Your answer
Membership
*
Family $50
Single Junior $40
Single Senior $40
Life Member $0
Please list Family members & DOB
*
Your answer
Preferred Discipline
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Mx
Speedway (sidecars, solos or flat track)
Speedway Cars ALL CLasses
Karts
Required
Ambulance Cover Details
*
YES
NO
Required
Bank details BSB 012-551 ACC # 209867166 Broken Hill Speedway Club Please put name as reference & leave payment date below
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