Mildura

MEMBERSHIP RENEWAL - SEASON 2021/2022 Please confirm your details below are correct and completed in full. Ensure your email address is included to receive race day updates . Name: Postal Address: Suburb: State: Post Code: Email Address: $20 Single Membership: Second Member Name: Second Member Mobile: 1. Online 2. Credit Card Visit our website milduraracingclub.com.au and click on the membership tab. Simply complete your details and process you payment. Note - There is no need to return this form if purchasing your membership online Visa Mastercard Bankard (Circle card type) Credit Card Number: Name on Card: Expiry Date: CCV: Signature: 3. Direct Debit Transfer your payment directly to our bank account & return this form to us. BSB: 013-006 Account No: 836139192 Reference: Your full name. Transfer Date: Reference Used: 4. Cheque or Money Order Make payable to “Mildura Racing Club” Send your fully completed form & payment to us via the below options: Email: mrc@countryracing.com.au Post: Mildura Racing Club PO BOX 10128, Mildura, Vic, 3502 $40 Double Membership: Second Member Email: HOW TO PAY Mobile No: