Membership Application

Please complete the following
Title Surname
Initials Given Name(s)
Preferred Name Date Of Birth
Address
Suburb Postcode
Phone (Hm) Phone (Wk)
Phone (Mb) Fax
Email    
Occupation Employer
Work Address
Membership Type
If the nominated category is closed, do you wish to enter a lesser category until vacancies become available? No Yes
Details of other sporting and social club membership past and present
I hereby agree that, if elected, to abided by the Rules and By-Laws of the club

Please type the text from the image to the left or click here if you cannot read the image.
 
Acceptance of the application is conditional upon being accepted by the management committee
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