NOMINATION FOR MEMBERSHIP
Contact Info
Type of Membership:
Ordinary 1 Yr
Ordinary 5 Yrs
Ordinary 10 Yrs
Senior (>60) 1 Yr
Senior (>60) 5 Yrs
Senior (>60) 10 Yrs
Form of Address:
Dr
Miss
Mr
Mrs
Ms
Given Name(s):
Surname:
Email Address:
Street Address:
City:
State/Region:
Country:
Postal Code:
Telephone:
Mobile:
Fax:
Date of Birth:
Occupation:
Other Info
Have you ever been suspended/barred from this club or any other club?
Yes
No
If yes, details:
Agreement
I wish to receive promotional material by Email and/or SMS
Yes
No
I have read and understand the Privacy Statement
Yes
I hereby apply for election as a member of Maroubra Seals Sports & Community Club Limited. I declare that I have attained the age of 18 years, and stated date of birth is correct. When elected, I agree to abide and be bound by the Articles and Rules of the Club
Yes
Signature
Signature:
Date:
NB:If Nominee is under 21 years of age, proof of age must be produced when subscription is paid.
Office Use Only
Receipt No:
Date Paid:
Amount Paid:
Staff Sig:
Card No:
Date Joined:
I'SIDE CLUBS:
ID Check:
Print
Print this page