Membership Application

Membership Application

Italian Australian Sporting & Social Club
www.italianaustralianclub.com.au

499-501 Princes Drive, Morwell VIC 3840
Ph. 03 5134 3541

Inc. A0010433A
Salutation

MrMrsMissMs
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Mobile Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Email
example@example.com
Addresses

Postal Address is the same as Residential AddressPostal Address is different to the Residential Address
Residential Address

Street Address

Street Address Line 2

CityState

Post Code
Postal Address

Street Address

Street Address Line 2

CityState

Post Code
I wish to receive special offers, discounts & promotions via email

YesNo

Privacy Statement

The Italian Australian Sporting & Social Club is subject to the provisions of the Privacy Act 1988. The personal information provided by you will be used to process your membership. Failure to provide all requested info may result in your membership being rejected. You have full rights to access your information & we do not disclose any personal information unless there is a legal requirement to do so. Any third party under contract to the club are required to keep all personal information confidential. Information may be used to improve & promote our services.
I hereby certify that I am over eighteen (18) years of age and that the above details are accurate and true.

YesNo