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Online Membership Form

Annual Subscription
New and Current Members
$40 for the period 1 July 2024 - 30 June 2025

Downloadable Form

Member Details

* Indicates required field

Primary Member Name *

First

Last

Street Address *

Town / City *

Postcode *

Home Phone *

Mobile *

Email *

Secondary Member Name *

First

Last

Mobile *

Email *

Car Details

Make *

Model *

Year *

Engine *

Reg No. *

Colour *

Additional information *

Indemnity

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

Acceptance of Indemnity *

Yes

Member Type *

New Member Renewal

Payment Method *

Direct Credit (Please make payment via your Online Banking facility, bank details below) Cash

Direct payment to ANZ Bank Acc No: 11-7901-0193358-11

Cheques will no longer be accepted by our bank. Direct bank transfer payments are now the club's preference, however if this is not possible, please contact the Treasurer to arrange a cash payment. Call 027 432 8018.

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