Membership Application

Membership Application

Southern Queensland Sliders - Membership will be for 12 months from date of purchase. Your application will be assessed by the Committee of the Southern Queensland Sliders and an invoice will be forwarded once approved (within 7 days of receipt)
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

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

DayMonthYear
Parent/Guardian if 18 Years or Under

First NameLast Name
Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number
Please enter a valid phone number.
NRHA Membership Number
Why do you wish to join the Southern Queensland Sliders?*
Type of membership required*
Names and NRHA Membership Numbers of other members, if Family membership is selected.
Should be Empty: