MEMBERSHIP FORM

MEMBERSHIP FORM

Membership Type*

Veteran Member (70+)

Aged 70+

$75.00AUD Quantity
Item subtotal:$0.00AUD

Adult Member (18+)

Aged 18+

$95.00AUD Quantity
Item subtotal:$0.00AUD

Cadets

Aged 15-17

$55.00AUD Quantity
Item subtotal:$0.00AUD

Junior Member

Aged 4-14

$25.00AUD Quantity
Item subtotal:$0.00AUD

Total

$0.00AUD

Credit Card

I/We are current member/s of RBAA, and my contact details and emergency contact details have not changed since my last membership renewalI/We are new members or I/we wish to change our contact details and emergency contact details
Veteran Member Name*

First NameLast Name
Preferred Name
Date of Birth*

DayMonthYear
Date
Phone*
Email*
example@example.com
InshoreOffshore
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Contact Number*
Relationship*
2nd Veteran Member Name *

First NameLast Name
Preferred Name
Date of Birth (2nd Member)*

DayMonthYear
Date
Phone (2nd Member)*
Email (2nd Member)*
example@example.com
InshoreOffshore
Same As AboveDifferent Address
Address (2nd Member)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (2nd Member)*

First NameLast Name
Contact Number*
Relationship*
3rd Veteran Member Name*

First NameLast Name
Preferred Name
Date of Birth (3rd Member)*

DayMonthYear
Date
Phone (3rd Member)*
Email (3rd Member)*
example@example.com
InshoreOffshore
Same As AboveDifferent Address
Address (3rd Member)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (3rd Member)*

First NameLast Name
Contact Number*
Relationship*
Adult Member Name*

First NameLast Name
Preferred Name
Date of Birth*

DayMonthYear
Date
Phone*
Email*
example@example.com
InshoreOffshore
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Contact Number*
Relationship*
2nd Adult Member Name *

First NameLast Name
Preferred Name
Date of Birth (2nd Member)*

DayMonthYear
Date
Phone (2nd Member)*
Email (2nd Member)*
example@example.com
InshoreOffshore
Same As AboveDifferent Address
Address (2nd Member)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (2nd Member)*

First NameLast Name
Contact Number*
Relationship*
3rd Adult Member Name*

First NameLast Name
Preferred Name
Date of Birth (3rd Member)*

DayMonthYear
Date
Phone (3rd Member)*
Email (3rd Member)*
example@example.com
InshoreOffshore
Same As AboveDifferent Address
Address (3rd Member)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (3rd Member)*

First NameLast Name
Contact Number*
Relationship*
Cadet Member Name*

First NameLast Name
Preferred Name
Date of Birth*

DayMonthYear
Date
Phone*
Email*
example@example.com
InshoreOffshore
Same As AboveDifferent Address
Address (Cadet Member)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cadet Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Contact Number*
Relationship*
2nd Cadet Member Name *

First NameLast Name
Preferred Name
Date of Birth (2nd Cadet)*

DayMonthYear
Date
Phone (2nd Cadet)*
Email (2nd Cadet)*
example@example.com
InshoreOffshore
Same As AboveDifferent Address
Address (2nd Cadet)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (2nd Cadet)*

First NameLast Name
Contact Number*
Relationship*
3rd Cadet Member Name *

First NameLast Name
Preferred Name
Date of Birth (3rd Cadet)*

DayMonthYear
Date
Phone (3rd Cadet)*
Email (3rd Cadet)*
example@example.com
InshoreOffshore
Same As AboveDifferent Address
Address (3rd Cadet)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (3rd Cadet)*

First NameLast Name
Contact Number*
Relationship*
Junior's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Contact Email*
example@example.com
Associated Senior Member*
Emergency Contact*

First NameLast Name
Contact Number*
Relationship*
2nd Junior's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Contact Email*
example@example.com
Associated Senior Member*
Same As AboveDifferent Emergency Contact
Emergency Contact (2nd Junior)*

First NameLast Name
Contact Number*
Relationship*
3rd Junior's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Contact Email*
example@example.com
Associated Senior Member*
Same As AboveDifferent Emergency Contact
Emergency Contact (3rd Junior)*

First NameLast Name
Contact Number*
Relationship*
4th Junior's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Contact Email*
example@example.com
Associated Senior Member*
Same As AboveDifferent Emergency Contact
Emergency Contact (4th Junior)*

First NameLast Name
Contact Number*
Relationship*
5th Junior's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Contact Email*
example@example.com
Associated Senior Member*
Same As AboveDifferent Emergency Contact
Emergency Contact (5th Junior)*

First NameLast Name
Contact Number*
Relationship*
Email Address for Membership Receipt*
example@example.com
I, First Name* Last Name* , hereby submit my application for membership in Rainbow Beach Amateur Anglers fishing club and agree to abide by the Constitution and By-laws of the club.
I/We consent to the Rainbow Beach Amateur Anglers Inc. using the name, image/photograph or video of the persons listed on this Membership Form, in the following; club newsletter, social media, other internet sites, traditional media, annual reports, promotional/advertising material and presentation or displays.I/ We acknowledge that as member/s of the Rainbow Beach Amateur Anglers I/we may be required to assist with the fundraising activities of the club by selling a book of raffle tickets each year.
Date Submitted*

DayMonthYear
Date
Please verify that you are human*
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