Individual or Main Member

Title:..........................  First Name:................................................................

Last Name:  .....................................................................

Business Name:  .....................................................................

(Corporate membership only)

Address: ................................................................................................................................................

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.....................................................................................................................................................................

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Postcode:.................................................

Home Phone No:.........................................................................

Mobile Phone No:........................................................................

Email address:..............................................................................................

Family Membership 

Family Member 2

First Name.........................................................

Last Name...........................................................

DOB (if 16 or under)........................................

Family Member 3

First Name.........................................................

Last Name...........................................................

DOB (if 16 or under)........................................

Family Member 4

First Name.........................................................

Last Name...........................................................

DOB (if 16 or under)........................................

I'm happy for photographs of my minor(s) to be used in publicity including publications and website. 

Signature ........................................................................................ Parent/Guardian        Date .........................................