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)

 

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. We are required to provide the Garage address to meet the ACT Registration requirements.

Genuine GT or Replica *

• Genuine GT
• Replica GT
• N/A

At Least one area must be checked.

Model *

• XR
• XT
• XW
• XY
• XA
• XB
• EB
• EL
• BA
• BF
• FG
• N/A

At Least one area must be checked.

Year

Body *

• Sedan
• Coupe
• N/A

At Least one area must be checked.

Colour

Non GT: 1967 to 1978 *

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

At Least one area must be checked.

Other

Type *

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

At Least one area must be checked.

Year

Body *

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

At Least one area must be checked.

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!