Membership Application - Campbelltown Catholic Club
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1
2Membership Application
Campbelltown Catholic Club
Membership Type
1 Year ($8)
3 Years ($20)
5 Years ($30)
10 Years ($50)
Title
First Name
Surname
Home Address
Suburb
Postcode
Mailing Address
if different from above
Suburb
Postcode
Phone
(Home)
(Work)
)
(Mobile
Email Address
/
/
Date of Birth
Country of Birth
dd/mm/yyyy
Language/s spoken at home
Are you Catholic?
Yes
No
Staff # if a Club Employee
Yes
No
Do you wish to receive general promotional material from the Club?
Do you wish to receive gaming related promotional material from the Club?
Yes
No
Post
Email
No
Do you wish to receive a copy of the Club’s Financial Reports?
Privacy Statement
The Campbelltown Catholic Club is subject to the provisions of the Privacy Act 1988. See over for full details.
Declaration
I, the undersigned, am over the age of 18 years, and I agree, if accepted as a Member to abide by the Rules,
Regulations and By-Laws of the Club.
/
/
Signature
__________________________________________________
Date
dd/mm/yyyy
Membership Proposed by
Member Number
Signature __________________________________________
Staff Use Only
ID Type
Drivers Licence
Passport
NSW Photo Card
Other ______________________
/
/
New Member #
Your Staff #
Date
CAMPBELLTOWN CATHOLIC CLUB | 20-22 Camden Rd Campbelltown 2560 | (02) 4625 0000 |
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