Membership Application Form

Jaguar Drivers' Club of Queensland Inc. (IA 18106)

PO. Box 3513, South Brisbane, Queensland, 4101

I/We wish to apply for membership of the JDCQ                                 Date: ___ /  ___ /200__

Enclosed is $                being the Membership Fee and Joining Fee..

SURNAME:________________________________________________________________

GIVEN NAME(S) Please list the names of ALL immediate Family Members who are 17 years

or over who wish to be Family members of the club.

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Details of Jaguars / Daimlers Presently Owned

Signature:___________________________________