YAMAHA XS-650 CLUB of AUSTRALIA

Send application including cheque/money order to:

David Rayner, 19 Thornbill Cres., Glenmore Park, NSW 2745, Australia.

MEMBERSHIP APPLICATION NAME; ______________________________________

ADDRESS; _____________________________________________________________

IS THAT CAPITAL CITY or COUNTRY ? (how far from capital)?____________

PHONE No; ____________________

T-SHIRT:- S /M /L /XL /XXL (circle)

E-MAIL ADDRESS; ______________________________________________________

WOULD YOU LIKE TO RECEIVE THE NEWSLETTER BY E-MAIL? Yes / No

MODEL XS-650 (if unknown, quote engine/frame numbers); _______________________

IS IT stock, custom, chopper, flat tracker, cafe racer, competition, other? (circle)

IS YOUR BIKE RUNNING (If not, roughly how long)? ___________________________

MOTORCYCLING INTERESTS (racing, touring, restoration, etc); __________________

QUESTIONS ABOUT THE XS (restoration, modification, what fits what)

YOU'D LIKE ANSWERED; ________________________________________________

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ARTICLES YOU'D LIKE TO SEE IN FUTURE NEWSLETTERS;

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FREE BUY/SELL AD YOU'D LIKE TO PLACE IN NEXT NEWSLETTER;

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ANY OTHER COMMENTS; ________________________________________________

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