The Servies Group

FULL MEMBERSHIP APPLICATION

Please complete below application

YOUR CLUB:

Your Local Club
to collect your members card?^*

APPLICANT DETAILS

Gender:^*

First Name:^*

Middle Name:^*

Surname:^*

Phone:^*

Email:^*

Occupation:^*

Date Of Birth:^*

ADDRESS

Street No. Street Name:^*

Town:^*

State:^*

Postcode:^*

POSTAL ADDRESS

Street No. Street Name OR PO Box:^*

Town:^*

State:^*

Postcode:^*

PROMOTION / MARKETING

Do you wish to receive promotional material:^*

YOUR CLUB:

Which club will you be visiting to collect your members card?

Please select your local or preferred club:^*

MEMBERSHIP TERM

1 YEAR - $12

2 YEAR - $20

3 YEAR - $28

MEMBERSHIP FEE

Payment of Membership Fee of:

will be collected at Club Reception.