2025 MDD Member Form

Membership Application

To sign up for a 2025 MDD membership please complete all questions.
Name (Use your preferred first name)*

First NameLast Name
Address*

Street Address

Street Address Line 2

SuburbState

Postal
Birthday*

DayMonthYear
Why are we asking this? So we can give you free entry in your birthday month!
YesNoNot Sure
If you are a returning member, what is your membership number?
Leave blank if you are new to the club, don't remember or have lost your card. We will check records for your number or assign you a new one
Yes
Yes
Yes - You may use images that include meNo - You may not use images that include mePlease talk to me before images are used
E-mail*
Signing Date*

DayMonthYear
Date