Application for Membership

Surname:            ____________________________________________

Given Name:      ____________________________________________

Address:             ____________________________________________

                            ____________________________________________

                            ____________________________________________

Telephone No.: __________________

E-mail:                 _____________________________

Date of Birth:         /        /             ( year optional over 18 y.o )

For Family Membership:

        Name:_____________________________________D.O.B ____/_____/_____

        Name:_____________________________________D.O.B ____/_____/_____

        Name:_____________________________________D.O.B ____/_____/_____

        Name:_____________________________________D.O.B ____/_____/_____

        Name:_____________________________________D.O.B ____/_____/_____

Optional: any trade or other skills that may be useful to the club:___________________

___________________________________________________________________

Membership Fees:

    Family Membership:     $20

    Adult single18yrs+        $10

    Student ( full time )        $4

    Pensioner single            $8         

    Family Pension Rate    $15

Half Yearly Rates available  ( Jan > June )

Club Badges can be purchased from the Secretary of Treasurer

With acceptance as a member, I agree to support the Conditions of Membership as well as the Aims and Objectives of the Redlands Modern Country Music Club Incorporated as details in the Club Constitution.

Privacy of Information

Any personal information given with this membership application will be kept private and only used to assess the membership application and for no other purpose.

SIGNATURE: _____________________________________ DATE: ______/______/________

  RMCMC   PO Box 663    Capalaba  Qld. 4157       ABN : 91 027 844 761