Application / Transfer Form Click here to download   

We, the undersigned, being financial member(s) of the Campervan and Motorhome Club of Australia Inc. hereby apply for application / transfer to the Highway Wanderers Chapter. Due to strict privacy laws, it is prohibited to print information pertaining to members without their written permission. Please copy & paste this page into an email, fill out & send to  info@highwaywanderers.com so our files can be updated to reflect the latest information.

                            Yes will give authority for the information to be printed.   Delete the one you don't want. 

Current Home Chapter ________________________________________________
(If not Highway Wanderers)
Membership Number ___________________________

Surname(s)                       _______________________________________________        Yes / No

First Name(s)                     _______________________________________________ 

                                       So that we can help you celebrate your birthday we ask you to provide either
                                       some or all of your details. You only need tell us the day and month if you
                                       don’t want us to know how young you are.

Date of Birth:                      ___/____ /____(Year optional)   ____/____ /____(year optional)

Address / PO Box Number       ________________________________________________    Yes / No

Town / City / Suburb             ________________________________________________    Yes / No

State / Territory                   ____________________          Postcode ____________       Yes / No

Phone Number                      ____________________          Fax __________________     Yes / No

Mobile Number                     _________________________________                              Yes / No

Email Address                       ________________________________________________     Yes / No

Vehicle Name                       ________________________________________________     Yes / No

Chapter Levy of $10 is enclosed ______________________________________________     Yes / No

Signed _________________                       Signed _________________               Signed ________________

Date ____/_____/______                          Date ____/_____/______                   Date ____/_____/______

Top of Page  Back to Forms