Albany SLSC Payment Plan Agreement

Albany SLSC Payment Plan Agreement

Please complete this application form to apply for a payment plan and to be able to register for the 2025-26 season at Albany SLSC. If you have any questions about this payment plan, please contact our Member Services Team via memberservices@albanysurfclub.com.au or registrar@albanysurfclub.com.au. Alternatively, please phone 08 9841 3327.
Name of member applying for payment plan*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please list the names of members that you would like included in this payment plan:*
$410 Family - 2 Adults + 2 Children (U18)$460 Family - 2 Adults + 3 Children (U18)$510 Family - 2 Adults + 4 Children (U18)$100 Little Nipper (Under 6 and U7) (Parent or Family membership required)$160 Nipper (U8 to U13) (Parent or Family membership required)$80 Nipper Parent$160 Youth (U14 to U19)$160 Active Senior - Student aged 19+ (evidence required)$195 Active Senior - Ages 19+$195 Long Service$110 General Volunteer
Choose my own instalment dates (please select below)Albany SLSC to select instalment dates and send invoice
First Instalment

MonthDayYear
Date
Instalment Two

MonthDayYear
Date
Instalment Three

MonthDayYear
Date
Final Instalment

MonthDayYear
Date
Online bank transferSLSA Portal paymentCash paid to Club Office
Agreement to Payment Plan Conditions
By signing this Payment Plan form, I agree that:
• I am in good standing with the Albany Surf Life Saving Club.
• I understand that this is NOT a direct debit arrangement, I am required to make the instalment payments as per my proposed payment method by my stated due dates
• I understand that I, and/or my family cannot represent the Albany Surf Life Saving Club in any sanctioned events, carnival, competitions, or leadership opportunities until I have paid my/our membership fees in full.
Signature*

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