Membership Renewal Form

NOMINATION / RENEWAL (MEMBERSHIP)
Title*

MrMrsMsMissOther
Membership*

NewRenewal
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of birth*

DayMonthYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Membership application subject to committee approval
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 - $110.00Concession (+60) Membership - $55.00Young Member (under 35) Membership - $55.00
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.au ABN: 67 682 038 583
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NOMINATION / RENEWAL (MEMBERSHIP)