Application for Returning Member
Griffith Musician's Club Inc.
Returning 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.
Format: 0000 000 000.
Email
*
example@example.com
Address
*
Street Address
City
State
Postal Code
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Membership Number (Renewing members only)
*
The number that appears on your lanyard (eg. 012)
Returning Member
Please indicate your instruments played
Instruments Played
*
Guitar
Bass
Keyboards
Drums
Vocals
Saxaphone
Clarinet
Flute
Violin
Harmonica
Accordion
Ukulele
Other
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Next
Membership Payment Details
Please choose the appropriate option
(Click the radial button to select)
*
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( X )
Returning Member
$10.23 AUD
$
10.23
AUD
Credit Card
Submit
Should be Empty: