Online Membership Form
$40.00 for 2017/2018 due now
New Members Only
$40 for new members joining between 1/4/17 & 31/12/17
$40 for new members joining between 1/1/18 & 31/3/18 for the current year plus the year following
Town / City
Spouse / Partners Name
In consideration of the acceptance of my membership and of my being permitted to take part in club events, I agree to save harmless and keep
indemnified the Southern Lotus Register Inc., (SLR), all the owners and tenants of private property traversed by a Club event, the committee members, Club members, fellow entrants, drivers and passengers, servants, representatives, agents and all persons having any connection with SLR from and against all losses, actions, claims, expenses and demands in respect of death, injury, loss or damage to persons or property of myself, my drivers, passengers or any other persons whatsoever howsoever caused arising out of or in connection with any club event, notwithstanding that such death, injury, loss or damage may have been contributed to or caused by the negligence of the SLR or any of the committee, Club members, representatives, agents or by any other person.
Acceptance / Payment Method
Renewal - Full
Renewal - Early Bird
New Member - 1st November
New Member 1st January
Direct Credit (Please make payment via your Online Banking facility, bank details below).
Direct payment to ANZ Bank Acc No:
Cheque payable to: Southern Lotus Register Inc.
Cheque post to:
Southern Lotus Register Inc.
6 Strathcarron Place
021 041 3447
(click on Sponsors logo for their website)
Last updated: 8th August 2017
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