First Name Surname

Address Suburb State

Home Phone Mobile

Email (required)

Date of Birth (dd/mm/yyyy)  Male Female

Membership Number (if known)

If the application is for a FAMILY or HALF FAMILY membership, please complete for all other family members.

1. First Name Surname Spouse Date of Birth M/F MaleFemale

2. First Name Surname Spouse Date of Birth M/F MaleFemale

3. First Name Surname Spouse Date of Birth M/F MaleFemale

4. First Name Surname Spouse Date of Birth M/F MaleFemale

Please indicate the relevant division or membership type

Senior BasketballSoccerTennisJunior BasketballWACA CricketNetballJnr CricketJnr FootballLittle AthleticsSenior FootballLawn BowlsConc. $27.50Half Family $44Family $88Social (Non Voting) $22Social (Voting) $44

I hereby apply for Membership of the Willetton Sports Club Inc. I understand that my rights and privileges do not commence until my application is approved. I agree to abide by the Rules & Regulations of the Willetton Sports Club Inc. (Please see our full Terms, Conditions, Rules, Regulations and Code of Conduct)

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