REGISTRATION FORM 2017; for non competing athletes only.

Glenhuntly Athletic Club

Membership Form 2017-18

To be used for Club Training and Club Supporter membership only.

 

DO NOT USE THIS FORM IF YOU PLAN TO COMPETE FOR THE CLUB

 

Note: Non-competing members may upgrade to competing membership at any time.

 

** Competing members register online with Athletics Victoria: members.athsvic.org.au

 

Family Name:

 

Given Name(s)
Address:

 

Phone: (H)

 

(M)

 

Email:

 

Date of Birth:

 

Gender (M or F):
Disability: (Y or N) Disability Classification:

 

Emergency Contact:

 

Contact No.
Relationship to contact.

 

School /Employment:

 

 

Membership Fees

Club Training    Senior

(recreational runner)

Junior U20

 

Non Competing

$92

 

$52

Provides training with the club, access to the club coaches and club facilities,
Club Supporter (social)

 

$40 Provides access to club activities

 

Payment Details:

Cash/ Cheque/ Money Order :

Payable to Glenhuntly Athletic Club Inc.

Funds Transfer: Bendigo Bank      BSB # 633 000     Account # 139 341 002

Signed: ____________________________________   Date: ________________________

(Parent/Guardian if U18)

 

Please Return completed form to the Club Registrar.

Julie Nield   76 Landcox Street, Brighton East VIC 3187

0420 908 242

Email: julienield@hotmail.com

Advertisements