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 ?

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

Are you transferring from another club?

Payment Method

ANSMA Verification

Membership Payment

AUD..

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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

Membership Payment*

Membership Payment