KNOX BICYCLE TOURING CLUB INCORPORATED PO BOX 6023 VERMONT SOUTH VICTORIA 3133 APPLICATION FOR MEMBERSHIP
NAME:
ADDRESS:
TELEPHONE:	HOME:	WORK:		MOBILE:
MEMBERSHIP TYPE:	HOUSEHOLD: $25.00		STUDENT/PENSIONER/CONCESSION $13.00
DATE:
SIGNATURE :
(Signature of parent or guardian is required if applicant is under sixteen years of age)