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The National Pilot Vehicle Drivers Association Inc.

(Incorporated under the Associations Incorporation Act 2015

ARB - 147 995 873

!/We:  ___________________________________________________________________________________________________________

Full Name/s of Applicant/s,(please print)

Address:  ________________________________________________________________________________________________________

Suburb:  ________________________________________________      State:  __________________________      Postcode:  __________

Phone:  __________________________________________                     Mobile:  ______________________________________________

Fax:  ____________________________________________          email:  _____________________________________________________

Hereby apply to become a member of the above named incorporated Association and agree to be bound by the rules of the Association currently in force.

Single Membership                                                        Family Membership                                              Group Membership

Please indicate above (family membership is open to two (2) family members or Groups more than three (3) members

who are qualified pilots

Please check our website for current Membership Fees

Signed:  ___________________________________________________________      Date:  ___________________________

Nominated By:  ______________________________________________________ 

                                             (please print name)

Signature:  __________________________________________________________      Date:  ___________________________

Please complete form and forward to;         snail mail:                     The Secretary, NPVDA, PO Box 390, Endeavour Hills, Vic, 3802

                                                                     email:                   OR

                                                                     fax:                                Secretary - 03 8456 5949

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