APPLICATION FOR MEMBERSHIP
TITLE: Mr / Miss / Mrs / Ms (please circle)
NAME: ________________________
FEES ARE GST INCLUSIVE NEW MEMBERSHIP FEES Entrance Fee
$16.50 Annual Fee
$22.00 Total
$38.50 (
) (note: yearly renewals June-July
only. Annual Fee $22.00) MID YEAR FEES (from January to July ONLY) ½ Yearly Fee
$11.00 Entrance Fee
$16.50 Total
$27.50
(
) PENSIONER FEES (pensioner ID required) Pen Annual Fee
$11.00 Entrance Fee
$16.50 Total
$27.50 (
) OFFICE
USE ONLY
SURNAME: _________________________________
OTHER NAMES: _________________________________
POSTAL ADDRESS: _________________________________
(renewal notice will
be sent here) _________________________________
_________________________________
PHONE No: Home( )______________________________
Business( )____________________________
Mobile ____________________________
EMAIL:________________________________________________
DATE OF BIRTH: ______/______/________
Proposed by:_______________________MemberNo:__________Signature:________________________
Seconded by:_______________________Member No:__________Signature:________________________
PLEASE NOTE:
PROOF OF AGE AND IDENTIFICATION MUST BE PRODUCED ON REQUEST
FOR VIDEO ACCESS, TELEPHONE NUMBER MUST BE SUPPLIED
FEES DUE, AS ABOVE MUST ACCOMPANY THIS APPLICATION
MEMBERSHIP CARD OR RECEIPT MUST BE PRODUCED UPON REQUEST.
I acknowledge that a membership card will be issued prior to my application being approved by the Management Committee.
In the event that this application is unsuccessful I understand that the membership card will be cancelled.
I certify that I am over the age of eighteen years and agree to abide by the rules of The Arnhem Club Incorporated
SIGNED:_____________________DATE:_____/_____/_______
OFFICE USE ONLY
IDENTIFICATION