Club Membership Application

If you wish to join the Prius Club of Queensland Inc., please complete the form below and press Submit. The Club will contact you further regarding payment methods.

You should peruse the Club's Constitution and Privacy Statement before submitting this application.

Application Form


I support the Objects of the Prius Club of Queensland Inc. as described in the Club's Constitution and I wish to submit an application for membership.

Full Membership:
Membership fees are $30 per year. There is an additional Joining Fee of $10 in the first year.
Associate Membership:
If you live outside South-East Queensland, you are able to join as an Associate member for an annual fee of $20. There is an additional Joining Fee of $10 in the first year.

Membership Fee
Joining Fee
Donation (optional)

Total AU$      

First Name:         Last Name:
Partner First Name:         Partner Last Name:
Address:
 
Suburb/Town:
State/Territory:
Postcode:
Home phone:         Mobile:
Email:
Vehicle Model/Colour:         Registration:

Include any additional information that you wish to provide here (max. 256 characters):

  characters remaining  

I state that I am at least 18 years of age, and that I am the registered owner or driver of a Prius.