Membership Application Form
Name
*
First Name
Last Name
Please Enter Family Members Names (For family membership only)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Please verify that you are human (If you are a self aware combat robot, please ask your human to complete this form)
*
My Products
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Family Annual Membership
$
100.00
AUD
Single Person Annual Membership
$
80.00
AUD
Student Single Annual Membership
$
40.00
AUD
Credit Card
Submit
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