Membership Application/Renewal

Step 1 of 2

Please select if you are applying or renewing membership(Required)

Membership Application

Membership Renewal

Current Membership Number

Membership Type(Required)

Competition Membership – $150

Non-competition Membership – $75

Preferred Race Number(Required)

2nd Preferred Race Number(Required)

Personal Details

Name(Required)

First Last

Address(Required)

Address Suburb State Post Code

Mobile(Required)

Email(Required)

Enter Email Confirm Email

Payment Type(Required)

Direct Deposit

Credit Card (+ surcharge)

Credit Card Surcharge

Price: $ 0.00

Total

Direct Deposit details
BSB: 032 024
Acc #: 136961
Acc Name: PSCRAA
Reference: Your Name

Please email your remittance to club@prodsports.com.au

Credit Card(Required)

Card Details

Cardholder Name