MEMBERSHIP APPLICATION FORM

MEMBERSHIP TYPE: SINGLE COUPLE (please tick appropriate box)

If applying for single membership, please complete Part A only.

If applying for couple membership please complete Parts A & B.

Membership fees: Single $6.00, Pensioner/Student $3.00. Couple $10.00 Pensioner/Student $5.00

Part A	Part B (spouse/partner to complete)
Given Names	Given Names
Surname	Surname
Address Telephone number (H) (W )	Address Telephone number (H) (W)
Occupation	Occupation
Date of Birth, if under 18	Date of Birth, if under 18
Spouse/Partner Name (spouse/partner to complete Part B):	Spouse/Partner Name
Proposer’s Name	Proposer’s Name
Proposer’s Signature	Proposer’s Signature
Seconder’s Name	Seconder’s Name
Seconder’s Signature	Seconder’s Signature
In the event that this application being accepted, I shall abide by the rules and regulations of the club.	In the event that this application being accepted, I shall abide by the rules and regulations of the club.
Applicant’s Signature	Applicant’s Signature
Note: Membership Fess must be paid at time of submitting form. Fees will be refunded if application not accepted or unsuccessful.
Date of Board’s approval or rejection	Date applicant’s advised

Please send your completed form together with your cheque for your membership fees to the Club’s poatal address: PO BOX A789 Sydney South NSW 1235