Application Form - NRMA Motoring & Services

Membership Application

Fields marked (*) are mandatory and must be completed for your application to be processed.

Your Personal Details

Title *

First Name *

Middle initial

Last Name *

Date of birth *

- -

Sex *

Male Female

Company Name
If applicable

ABN - If applicable

Driver licence No.

Your Contact Details

Work phone number

Home / After hours phone number *

Contact email

Please send me email communications keeping me up to date with news, promotions and Member information.

Name of property / building

Address Line 1 *

Address Line 2

Town name *

State *

Postcode *

Are you a permanent resident of Australia or an Australian citizen? *

Yes No

Are you a member of a motoring organisation affiliated with NRMA? *

Yes No

Membership Package

New Membership administration fee of $55.00 payable on all package types.

Select your preferred membership package type *

Premium Care - view details

Club Care - view details

Classic Care - view details

Traveller Care - view details

Select your preferred period of membership *

1 Year

3 Years

5 Years

Your Vehicle

Vehicle use *

Private

Taxi

Motorbike

Truck

Rental

Company use

Registration number

Gift Voucher number

Payment

There are a number of payment options available once you receive your invoice for payment which will be received in 7 -10days.
Alternatively one of our consultants can call you within 24 hours to arrange payment by credit card.
PLEASE NOTE: you will not be covered for roadside assistance on your nominated vehicle until your payment has been made.

Please have a consultant call to process payment. *

Yes No

If you require immediate roadside assistance please call 13 11 22.

Declaration

Declaration *

When you pay for your membership you agree to become a Member of the National Roads and Motorists' Association Limited. This means that you agree to be bound by Your Membership Entitlements, and the Constitution of National Roads and Motorists' Association Limited.

Do you agree to become a member of National Roads and Motorists' Association Limited and to be bound by its constitution?

Yes No