2024 East Coast Eagles Club Membership

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How Many Memberships Would You Like to Purchase?* This field is required.
Quantity
Full Club Membership
1
2
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4
5
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7
8
9
10
Row 0, Column 0
Life Member Membership
1
2
3
4
5
6
7
8
9
10
Row 1, Column 0
Full Club Membership
Life Member Membership
Quantity
1
2
3
4
5
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7
8
9
10
Row 0, Column 0
Quantity
1
2
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Row 1, Column 0
1 of 2
2
Total Members
3
Member 1 - Name* This field is required.
First Name
Last Name
4
Member 1 - ECE Life Member* This field is required.If you are an ECE life member, please let us know.
YESNO
5
Member 1 - Email* This field is required.
example@example.com
6
Member 2 - Name* This field is required.
First Name
Last Name
7
Member 2 - ECE Life Member* This field is required.If you are an ECE life member, please let us know.
YESNO
8
Member 2 - Email* This field is required.
example@example.com
9
Member 3 - Name* This field is required.
First Name
Last Name
10
Member 3 - ECE Life Member* This field is required.If you are an ECE life member, please let us know.
YESNO
11
Member 3 - Email* This field is required.
example@example.com
12
Member 4 - Name* This field is required.
First Name
Last Name
13
Member 4 - ECE Life Member* This field is required.If you are an ECE life member, please let us know.
YESNO
14
Member 4 - Email* This field is required.
example@example.com
15
Member 5 - Name* This field is required.
First Name
Last Name
16
Member 5 - ECE Life Member* This field is required.If you are an ECE life member, please let us know.
YESNO
17
Member 5 - Email* This field is required.
example@example.com
18
Member 6 - Name* This field is required.
First Name
Last Name
19
Member 6 - Email* This field is required.
example@example.com
20
Member 7 - Name* This field is required.
First Name
Last Name
21
Member 7 - Email* This field is required.
example@example.com
22
Member 8 - Name* This field is required.
First Name
Last Name
23
Member 8 - Email* This field is required.
example@example.com
24
Member 9 - Name* This field is required.
First Name
Last Name
25
Member 9 - Email* This field is required.
example@example.com
26
Member 10 - Name* This field is required.
First Name
Last Name
27
Member 10 - Email* This field is required.
example@example.com
28
Total Cost
29
Payment Method* This field is required.How would you like to make payment?
Credit/Debit Card
Bank Transfer
30
Bank Account Details

Amount: ${totalCost}

Account Name: East Coast Eagles AFL Club Inc.

BSB: 082-343

Account Number: 893651176

Reference: 2025 ECE Club Membership - {member12}
31
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