Car Insurance Australia - Car Enthusiasts - Classic Car Insurance

Simply complete the following details in full, including the names and of two club members, and submit this form

In consideration of Shannons Limited ABN 91 099 692 636 on behalf of Australian Alliance Insurance Company Limited ABN 11 006 471 709 giving access to the Shannons website to promote the club and its activities, we hereby indemnify Shannons Limited and Australian Alliance Insurance Company limited against all liabilities, claims. actions, proceeding, losses and damages of whatsoever nature incurred by you and arising out of or in consequence of our use of the Shannons’ website.

Club Information

Club Name*

Email*

Phone*

Mobile

Postal Address*

Suburb*

Postcode*

State*

Note: these details will appear on the Shannons Car Club listing

Club member details:

Name*

Position in club*

Name*

Position in club*

*Required Fields

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