MEMBERSHIP

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Email Address *

Mobile Phone Number *

Emergency Contact Name *

Emergency Contact Mobile No *

Vespa Model & Registration No *

Credit / Debit Card *

By completing your card details a Membership Fee of $50.00 will be deducted from your card.