Membership Form

Please do not use this form yet, it is being tested at the moment

Name

First Name

Last Name

AUS Number

Address

Please enter your Postal Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate

Please enter your birth date

YYYY

Phone Number

Please enter your phone number

(###)

###

####

Occupation

New/Renewing

Please choose either New membership or Renewing membership

Membership Type

Please select membership required

Centerlink No.

Please enter your Centerlink number for Pensioner Membership

Do you require a Club Instructor

Yes

Do you hold a First Aid certificte

Yes

Payment Type

Cash or Cheque

Direct Deposit