Membership Form

 

 

When filling out the form, keep in mind there are three sections, the first section is for basic contact information, the second is for Genuine GT Falcons or Replica’s and the third section section is for Non GT’s.
Areas with a RED Asterix * are required to be filled in or you may select N/A (Not Applicable)

 

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First Name *

Last Name *

Mobile Number *

Email *

Email

Confirm Email

Please Add your Email Address here.

Address: *

We only ask for your Suburb not Full Address. UNLESS: you are looking at Historic Vehicle Registration, Classic Rego requires full address. We are required to provide the Garage address to meet the ACT Registration requirements.

Genuine GT or Replica *

• Genuine GT
• Replica GT
• Special Interest - Add details below, in Special Interest Details.
• N/A

At Least one area must be checked.

Special Interest Details.

Special Interest Car? Please check with the President or Registrar if selecting a special interest car Prior to filling in this form.

Model *

• XR
• XT
• XW
• XY
• XA
• XB
• EB
• EL
• BA
• BF
• FG
• Other Model, Special Interest.
• N/A

At Least one area must be checked or select N/A

If Other is selected add in Model details here, only if other is selected and a special interest car has been approved.

Special Interest Car? Please check with the President or Registrar if selecting a special interest car.

Year

Body *

• Sedan
• Coupe
• UTE
• N/A

At Least one area must be checked or select N/A

Colour

Non GT: 1967 to 1978 *

• XR
• XT
• XW
• XY
• XA
• XB
• XC
• N/A

At Least one area must be checked or select N/A

Other

Type *

• Cobra
• Fairmont
• Fairlane
• Ltd
• Landau
• N/A

At Least one Type must be checked or select N/A

Other Type - Special Interest.

Year

Body *

• Sedan
• Coupe
• Station Wagon
• Ute
• N/A

At Least one Body Type must be checked or select N/A

Colour

Submit

Once this form has been received and your membership has been approved you will receive an invoice with payment details.
Joining Fee – $10
Annual Membership Fee – $50  ($60 for a first time member.)

 Banking Details – for Membership.
 Falcon GT Club of Canberra inc.
 ANZ  BSB 012936
 Acct. No: 482611276

Cheers and welcome to the Club!