Social Membership

Upon submission of this application, your membership account will be created at the club and you will be contacted for payment and redemption.

Social Memberships cost $25 per year and expire at the end of June each year.

First Name*

Last Name*

Preferred Name

Gender*

Date of Birth*

Contact #*

Email*

Street Address*

Suburb*

State

Post Code*

Country

Privacy Statement

We will not use any of the above information on this form without your specific permission in writing other than to record you as a member or to communicate with you.

I'm happy to receive information relating to electronic gaming machines *

YesNo

Membership

Membership type

RESPONSIBLE GAMBLING