VERi membership form

* Email Address
* Full name
* Date of birth
* Address
* Suburb
* State	Vic NSW SA ACT Other
* Postcode
* Phone number
* Membership type	Single membership $50.00 Family membership $65.00
Additional members for family membership
Direct deposits to... Bendigo Bank Vintage Enduro Riders inc. BSB 633 000 Account No 149515694 Reference your full name
All membership renewals due 1st July
Please list motorcycles currently Club Permit Registered
Notes/comments
By joining VERi all memberss accept the following clauses, 1. If VERi or representative deems it necessary, we will call an ambulance to attend to an injured rider. It is up to all riders to ensure they have ambulance coverage. We won't ask permission first. 2. VERi reserves all other rights during the course of any event, including the right to exclude riders or machines; make changes to any event at short notice, and any other decisions the club deems necessary during the course of any events.
	Please tick/answer the captcha above.

Or alternatively you can download the form, fill it out, and

• post it to us,
• email it to treas@verivinduro.com.au, or
• pass it on in person at an event

If posting the form and / or cheque please send to:

VERi
PO Box 472
Traralgon
Victoria 3844 If paying by bank deposit, please include your membership number and name as the reference. If you can't remember or don't know your number, then just your name will do,

Bendigo Bank
Account name - Vintage Enduro Riders inc.
BSB - 633 000
Account No. - 149515694
Reference: Your number and/or name

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Membership fees

Memberships are valid from 1st July to the 30th of June