SUNBEAM OWNERS CLUB OF QUEENSLAND INC.

APPLICATION FOR MEMBERSHIP

Please fill out this form and forward with your A$50.00 cheque or money order to:

SOCQ. INC. c/- Bob Otto (Treasurer)

PO. Box 1130, Wynnum 4178

Queensland, Australia.

Name:……………………………………………………………………………...............…

Address:…………………………………………………………………………..............…

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email:

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Please indicate with a tick if you wish to receive your newsletter via email

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Phone No:…………………………………Mobile No:.…………………...........................

Please list all your cars (Sunbeams and any other classics).

Model                                                     Year                 Reg. No.             Colour

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Please indicate with a tick if you are willing to have your name and address published in a list of members in the newsletter “Sunstate Newsbeams” at a later date:

Yes      □                                No       □