New Membership Application

New Members Details

First Name *

Last Name *

Email *

Mobile Phone Number * (use format 0000 000 000)

Home Phone Number (use format 00 0000 0000)

Work Number (use format 00 0000 0000)

Occupation

Date of Birth *

Address * (This is where mail will be sent to Eg. TLCC News)

Suburb *

State *

Postcode *

Country *

Agree to TLCC Constitution & By-Laws * Yes

Have you previously been a TLCC Member? --Please Select-- yes no

How do you want to receive the TLCC News? --Please Select-- TLCC News plus eMag eMag Only None

Membership Type * --Please Select-- Family

New Members Vehicle Information

Vehicle 1 Make Eg. Toyota --Please Select-- Bedford Diahatsu Dodge Ford GMC GWM Holden Hummer Hyundai International Isuzu Iveco INEOS Jeep Kia Land Rover LDV Lexus Mahindra Mazda Mercedes Mitsubishi Nissan Oka RAM Subaru Suzuki Swagman Toyota Volkswagen Volvo

Vehicle 1 Model Eg. Land Cruiser --Please Select-- 1500 2500 3500 4 Runner Amarok B2600 Blizzard Bravo Bronco BT-50 Bundera Challenger Cherokee Classic Colorado County Courier D-Max D90 Daily Defender Delica Discovery 2 Discovery 3 Discovery 4 Discovery 5 Discovery Dl Drover Everest Explorer F100 F250 Feroza Fj Cruiser Forester Fortuner Freelander G300 Grand Cherokee Grand Vitara Grenadier Haval Hilux Hummer IO IX35 Jackaroo Jimny Land Cruiser Prado Land Cruiser Larado Lexus LT LX450d LX470 LX570 Maverick ML320 MU-X Navara Outback Pajero Pathfinder Patriot Patrol R Series Raider Ram Range Rover Ranger MK11 Ranger Raptor Rav 4 Renegade Rodeo Rogue Rugged X Scout Series 3 Sierra Sportage Surf T60 Terracan Terrano Touareg Trailblazer Transporter Tribute Triton Trooper Tundra Ute Vitara Wildtrack Willys Wrangler XC90

Vehicle 1 Description Eg. VDJ200 --Please Select-- 1 100 SERIES 105 SERIES 110 120 SERIES 130 CREW CAB 130 150 SERIES 1FEZ 1FZFE 1HDFT 1HDT 200 SERIES 2500 2500HD4x4 3.9 V8 300 SERIES 40 SERIES 4x4 5A 60 SERIES 73 SERIES 75 SERIES 75RV 76 SERIES 78 SERIES 79 SERIES 80 SERIES 90 SERIES 92Y 95 SERIES ACTIVE BJ40 BJ42 BJ70 BJ73 BJ74 BRAVO BT-50 BUNDERA CAMPER CANNON-L CANNON-X CANNON CANYON CLASSIC CREW CAB CRUSADE D21 D22 D40 DA DUAL CAB DX EARTH CRUISER EL3 ES TD5 EXCEED FJ25 FJ40 FJ45 FJ55 FJ60 FJ62 FJ73 FJ75 FJ80 FJ90 FJZ105R FREELANDER FX FX4 FZJ100 FZJ105 FZJ105R FZJ60 FZJ75 FZJ80R GL GLR GLS GLX-R GLX GLX+ GPW GQ GRANDE GR-S GSJ15R GT GU GU7 GUN126R GX GXL H6 H9 HDJ100R HDJ78 HDJ78R HDJ79R HDJ80R HI LINE HIGHLANDER HJ45 HJ47 HJ60 HJ61 HJ62 HJ63 HJ75 HJ79 HSE HUMMER HZ75 HZJ105R HZJ75 HZJ78 HZJ78R HZJ79R HZJ80 HZJ80R IO JIMNY JK JLX JN JT05A JT05B KAKADU KDJ120 KDJ120R KDJ150R KJ KN165 KUN26R KZN165R KZN185 L8 LAND88A LAND96B LARAMIE LAREDO LC78 LD10 LH100 LJ50 LN106 LN106R LN107 LN130 LN130R LN167 LN167R LN60 LN65 LN65R LS-M LS LST LTR LX LX470 LX570 M1026 MEGA TUB MK MK11 MN MOTOR HOME MQ MY2001 NB NE NF NG NH NJ NK NL NM NP NP300 NQ NS NT NW NX OVERLAND PA PAJ PATROL PB PE PG PRADO PX PX2 PX3 QE QT R50 R51 R52 RA RAPTOR RENEGADE RG RJ70 RN RN36 Rogue RUBICON Rugged X RV-6 RV6 RX SAHARA SAHARA ZX SDV6 SE SE SERIES 1 SERIES II SJ410 SPORT SR SR+ SR5 SR5+ SSR-G SSRX ST-L ST STATION WAGON STX SWB 88 SWB SX4 SXA TANAMI TD TD42 TD5 TDI TDI300 TDV6 TE TF TI TI550 TJ TRAVELLER TRAY BACK TREKKER TREND TROOPCARRIER TX TZ U8 UQ UTE UZJ100 UZJ200R V6 V8 VDJ200 VDJ200R VDJ76 VDJ78R VDJ79R VJ95 VOGUE VRX VX VZJ95R VZN130 Workmate WX XEI XJ XLS XLT XS XTR Y60 Y61 Y62 YN63 YN65 ZG ZR

Vehicle 1 Year of Manufacture

Vehicle 1 Rego

Vehicle 1 Fuel --Please Select-- Petrol Diesel Turbo Diesel LPG

Vehicle 2 Make Eg. Toyota --Please Select-- Bedford Diahatsu Dodge Ford GMC GWM Holden Hummer Hyundai International Isuzu Iveco INEOS Jeep Kia Land Rover LDV Lexus Mahindra Mazda Mercedes Mitsubishi Nissan Oka RAM Subaru Suzuki Swagman Toyota Volkswagen Volvo

Vehicle 2 Model Eg. Land Cruiser --Please Select-- 1500 2500 3500 4 Runner Amarok B2600 Blizzard Bravo Bronco BT-50 Bundera Challenger Cherokee Classic Colorado County Courier D-Max D90 Daily Defender Delica Discovery 2 Discovery 3 Discovery 4 Discovery 5 Discovery Dl Drover Everest Explorer F100 F250 Feroza Fj Cruiser Forester Fortuner Freelander G300 Grand Cherokee Grand Vitara Grenadier Haval Hilux Hummer IO IX35 Jackaroo Jimny Land Cruiser Prado Land Cruiser Larado Lexus LT LX450d LX470 LX570 Maverick ML320 MU-X Navara Outback Pajero Pathfinder Patriot Patrol R Series Raider Ram Range Rover Ranger MK11 Ranger Raptor Rav 4 Renegade Rodeo Rogue Rugged X Scout Series 3 Sierra Sportage Surf T60 Terracan Terrano Touareg Trailblazer Transporter Tribute Triton Trooper Tundra Ute Vitara Wildtrack Willys Wrangler XC90

Vehicle 2 Description Eg. VDJ200 --Please Select-- 1 100 SERIES 105 SERIES 110 120 SERIES 130 CREW CAB 130 150 SERIES 1FEZ 1FZFE 1HDFT 1HDT 200 SERIES 2500 2500HD4x4 3.9 V8 300 SERIES 40 SERIES 4x4 5A 60 SERIES 73 SERIES 75 SERIES 75RV 76 SERIES 78 SERIES 79 SERIES 80 SERIES 90 SERIES 92Y 95 SERIES ACTIVE BJ40 BJ42 BJ70 BJ73 BJ74 BRAVO BT-50 BUNDERA CAMPER CANNON-L CANNON-X CANNON CANYON CLASSIC CREW CAB CRUSADE D21 D22 D40 DA DUAL CAB DX EARTH CRUISER EL3 ES TD5 EXCEED FJ25 FJ40 FJ45 FJ55 FJ60 FJ62 FJ73 FJ75 FJ80 FJ90 FJZ105R FREELANDER FX FX4 FZJ100 FZJ105 FZJ105R FZJ60 FZJ75 FZJ80R GL GLR GLS GLX-R GLX GLX+ GPW GQ GRANDE GR-S GSJ15R GT GU GU7 GUN126R GX GXL H6 H9 HDJ100R HDJ78 HDJ78R HDJ79R HDJ80R HI LINE HIGHLANDER HJ45 HJ47 HJ60 HJ61 HJ62 HJ63 HJ75 HJ79 HSE HUMMER HZ75 HZJ105R HZJ75 HZJ78 HZJ78R HZJ79R HZJ80 HZJ80R IO JIMNY JK JLX JN JT05A JT05B KAKADU KDJ120 KDJ120R KDJ150R KJ KN165 KUN26R KZN165R KZN185 L8 LAND88A LAND96B LARAMIE LAREDO LC78 LD10 LH100 LJ50 LN106 LN106R LN107 LN130 LN130R LN167 LN167R LN60 LN65 LN65R LS-M LS LST LTR LX LX470 LX570 M1026 MEGA TUB MK MK11 MN MOTOR HOME MQ MY2001 NB NE NF NG NH NJ NK NL NM NP NP300 NQ NS NT NW NX OVERLAND PA PAJ PATROL PB PE PG PRADO PX PX2 PX3 QE QT R50 R51 R52 RA RAPTOR RENEGADE RG RJ70 RN RN36 Rogue RUBICON Rugged X RV-6 RV6 RX SAHARA SAHARA ZX SDV6 SE SE SERIES 1 SERIES II SJ410 SPORT SR SR+ SR5 SR5+ SSR-G SSRX ST-L ST STATION WAGON STX SWB 88 SWB SX4 SXA TANAMI TD TD42 TD5 TDI TDI300 TDV6 TE TF TI TI550 TJ TRAVELLER TRAY BACK TREKKER TREND TROOPCARRIER TX TZ U8 UQ UTE UZJ100 UZJ200R V6 V8 VDJ200 VDJ200R VDJ76 VDJ78R VDJ79R VJ95 VOGUE VRX VX VZJ95R VZN130 Workmate WX XEI XJ XLS XLT XS XTR Y60 Y61 Y62 YN63 YN65 ZG ZR

Vehicle 2 Year of Manufacture

Vehicle 2 Rego

Vehicle 2 Fuel --Please Select-- Petrol Diesel Turbo Diesel LPG

Partners Details

Spouse

Partner First Name

Partner Last Name

Partner DOB

Partner Mobile Phone Number (use format 0000 000 000)

Partner Work Phone Number (use format 00 0000 0000)

Partner Occupation

New Members Children

Child 1 Name

Child 1 Date of Birth

Child 2 Name

Child 2 Date of Birth

Child 3 Name

Child 3 Date of Birth

Child 4 Name

Child 4 Date of Birth

Child 5 Name

Child 5 Date of Birth

New Members Secure Zone Access

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Payment Details

Payment Type. (Please note AMEX Cards are not accepted.) Credit Card