Download Sample Club Membership Application Form Free Download for Free

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APPLICATION FOR MEMBERSHIP 20__ / 20__ SEASON
1. CLUB NAME _______________________________________________________________________________ SLSC
2. GENERAL DETAILS
I hereby apply for membership of SLSA. I have read, understood, acknowledge and agree to the declaration and application over leaf. I have signed that declaration
and application.
INITIAL MEMBERSHIP RENEWING
TITLE ____ (Mr, Mrs, Ms, etc) FIRST NAME ____________________ SECOND INITIAL ___ LAST NAME _______________________
MALE FEMALE DATE OF BIRTH ____ / ____ / ____ OCCUPATION ________________________________
ADDRESS __________________________________________________________________________________POSTCODE __________
PHONE: HOME ______________________BUSINESS ___________________________ FAX__________________________________
MOBILE ___ _________________ PREFERRED CONTACT NUMBER NO B / H / M EMAIL_ ___________________________
Drivers License License Number _____ ______________ Vehicle Type ________ _________ Exp Date _ ___________________
Shirt Size (Please Circle) 6 / 8 / 10 / 12 / 14 / S / M / L / XL / 2XL / 3XL / 4XL / 5XL
Short Size (Please Circle) S / M / L / XL / 2XL / 3XL / 4XL / 5XL
3. MEMBERSHIP DETAILS APPLIED FOR – SUBJECT TO CLUB ENDORSEMENT (Tick one box only)
PROBATIONARY……………………………….. ACTIVE (18 years and over)……… ASSOCIATE………………
JUNIOR ACTIVITY MEMBER (5-13 years) ……… AWARD MEMBER…………..… LIFE MEMBER……………
CADET MEMBER (13-15 years)………………… RESERVE ACTIVE………….… GENERAL..………………..
ACTIVE (15-18 years)…………………………… LONG SERVICE………….…… HONORARY………………
Date Joined ________________ Competitive Rights with this club: YES NO Locker Number ______ Key No _ _____
Member Protection Form Completed? YES NO Membership Protection Number (where applicable) _ _ ______________
4. OTHER SURF LIFE SAVING CLUB MEMBERSHIPS (Please attach list if more than two)
_______________________________________________ SLSC_______________________________________________________ SLSC
5. MEDICAL DETAILS
If you suffer or you have suffered from any disease or any physical or mental disability (eg, epilepsy, diabetes or any permanent disability to a limb,
eye or ear) likely to affect your efficiency as a Club member, it may affect your safety and the safety of the public. You should consult your
medical practitioner and SLSA prior to commencing any surf lifesaving activity. You should take part in a Hepatitis B vaccination program.
HAVE YOU READ THIS SECTION? YES NO
6. EMERGENCY CONTACT
FIRST NAME ___________________________________________LAST NAME ______ ________________________________________
RELATIONSHIP _ __________ADDRESS _____________________________________________________ POSTCODE ____________
PHONE: HOME _________________ BUSINESS __________________ FAX: __________________MOBILE: _____________________
7. BACKGROUND DETAILS
Are you from a culturally and linguistically diverse background? YES NO Cultural Background ________________________
Do you use any languages other than English in your home? YES NO Second Language ___________________________
Are you of Aboriginal descent? YES NO Are you of Torres Straight Islander descent? YES NO
8. DECLARATION I have read, understood, acknowledge and agree to the declaration and application and conditions of membership over leaf. I
have signed that declaration and application. I warrant that all information provided is true and correct.
SIGNATURE ________________________________________________________ DATE: _____________________________________
9. PARENT/LEGAL GUARDIAN CONSENT (IN RESPECT TO AN APPLICANT UNDER THE AGE OF 18 YEARS)
I have read, understood, acknowledge and agree to the declaration and application and conditions of membership overleaf and I personally consent to the
declaration and application for Membership of the applicant.
FIRST NAME _ ___________________________________________LAST NAME ____________________________________________
SIGNATURE ___________________________________________________ DATE ___ ________________________________________
10. OFFICE USE ONLY
Date Application received ____ / ____ / ____ Amount paid: $_________________ Receipt No. _ _________________________________
Accepted / Rejected by Club Management – Date ____ / ____ / ____ Signature of Club Officer _ __________________________________
Membership Category allocated _ ___________ Capitation/Membership No. __ __________ ID Sighted – Type _ _________ Date _______
Form 76 -07
Sample Club Membership Application Form Free Download
source: aallnet.org
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