Individual Membership (New)

First Name*

Last Name*

Please provide your email address. This MUST be a unique email address and not a shared email address with another ANSMA Member.

E-mail*

Phone Number

Area CodePhone Number

Please provide your residential address. This MUST be a NSW address. ANSMA membership and conditional car registrations are for NSW residents only.

Address*

City*

State*

Post Code*

Car Registration*

If no registration, type Not Regstered

Upload Car Photos*

Browse Files

Front, Rear, Side, Interior, Under Bonnet

Vehicle Details *

Please provide MAKE, MODEL, and YEAR of your vehicle

Rim Size*

Please tell us the rim size of your car/s

Is this vehicle modified ?*

YesNo

Modifications

Please provide details of the modifications to your vehicle, including any engineering certifications and their date of issue for the work.

Will you attend car shows, cruises, etc & support charity events*

YesNo

Are you transferring from another club? *

YesNo

Payment Method*

Credit CardCash

ANSMA Verification

Membership Payment*

AUD..

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Once your payment is received we will contact you with a confirmation email that includes your membership number, you will also receive a receipt for your payment.

Thank you!

Status

Paid To

Expiry Date

Date

Fee Due Date

DayMonthYearHourMinutes

Todays Date

DayMonthYearHourMinutes

Epoch Difference

Months Remaining

Minimum Months

Calculated Remaining Fee for the Year

Cash Amount Required

Fee Due Amount

Individual New Member