Coro Membership Application Form

Membership Application Form

Membership is not instantaneous and subject to board approval and final processing. Download our Coro Club App to win instant prizes, notifications, coffee, bar, raffles promos and heaps more. See you at the Coro!
Date*

DayMonthYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*

DayMonthYear
Date
Email*
example@example.com
Membership Type*

NewRenewal
Membership Number if known (for current member numbers only)
Note: If a membership has been expired for over 12 months, a new member number will be issued upon renewal.
I wish to be kept up to date with Club Marketing & Promotions?*

YesNo
I wish to receive the Club's Annual Financial Report via*

EmailView Online
PRIVACY STATEMENT

The Coro 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 application being rejected. You have full rights to access 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.
DECLARATION

By digitally signing, I hereby certify that I am over the age of 18 and I agree to abide by the Rules and Regulations of The Coro Club.
Signature*

Powered by Jotform SignClear

Membership Options. Note: Pensioners, please visit Club Reception to join.*

1 Year MembershipEnter description

$5.50AUD Quantity

3 Years Membership Enter description

$16.50AUD Quantity

5 Years Membership Enter description

$27.50AUD Quantity

Lifetime 20 YearsEnter description

$110.00AUD Quantity

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: