NOMINATION / RENEWAL (MEMBERSHIP)
Title
*
Mr
Mrs
Ms
Miss
Other
Membership
*
New
Renewal
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
*
-
Day
-
Month
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Proposer
Date
-
Day
-
Month
Year
Date
Membership #
Proposer
Date
-
Month
-
Day
Year
Date
Membership #
We the above, being Financial members of the ALICE SPRINGS TURF CLUB INC. HEREBY NOMINATE to membership the person named above, and in accordance with rule 6(1) of the Club’s Constitution, WE CERTIFY that such candidate for membership is well known to us and is a fit and qualified person to become a Member.
Membership type
*
Ordinary Membership Annual Subscription - $110.00
Concession (+60) Membership - $55.00
Young Member (under 35) Membership - $55.00
Submit
Ladbrokes Pioneer Park Racecourse, South Stuart Highway, PO Box 181, Alice Springs NT 0870 T: 08 8952 4977 F: 08 8953 0426 E: info@alicespringsturfclub.org.au W: www.alicespringsturfclub.org.auABN: 67 682 038 583
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