Application for New Membership
Griffith Musician's Club Inc.
New Member
Personal Details
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Applicant Gender
*
Please Select
Male
Female
Prefer not to say
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
City
State
Postal Code
Back
Next
New Member
Please indicate who referred you to the club & the instrument(s) you play
Proposer 1 Name
*
Proposer 1 must be a current financial Club Member
Proposer 2 Name
*
Proposer 2 must be a current financial Club Member
Instruments Played
*
Guitar
Bass
Keyboards
Drums
Vocals
Saxaphone
Clarinet
Flute
Violin
Harmonica
Accordion
Ukulele
Other
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Membership Payment Details
Please choose the appropriate option
(Click the radial button to select)
*
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( X )
New Member
$
11.24
AUD
Credit Card
Submit
Should be Empty: