JUNIOR PROGRAM APPLICATION FORM

JUNIOR PROGRAM APPLICATION FORM
Number of Applicants*
Applicants are to be 10 to 15 years old at the time of application
Applicants Name*

First NameLast Name
Preferred Name
Date of Birth*

DayMonthYear
Date
Membership Status*

Club Member ($95.00)Non-Member ($120.00)
2nd Applicants Name *

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

DayMonthYear
Date
Membership Status*

Club Member ($95.00)Non-Member ($120.00)
3rd Applicant's Name*

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

DayMonthYear
Date
Membership Status*

Club Member ($95.00)Non-Member ($120.00)
4th Applicant's Name*

First NameLast Name
Preferred Name
Date of Birth*

DayMonthYear
Date
Membership Status*

Club Member ($95.00)Non-Member ($120.00)
Parent or Guardian Contact Details
Parent or Guardian's Name*

First NameLast Name
Postal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*
Email*
The club Treasurer will invoice you upon confirmation of availability.
I am able to assist with the supervision of children during the program.I have a Working with children card (blue card)
I, First Name* Last Name* , hereby submit the above-named applicants for membership in Rainbow Beach Amateur Anglers Inc. Junior Program and agree to abide by the Constitution and By-laws of the club.
I 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.
Date Submitted*

DayMonthYear
Date
Please verify that you are human*
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