Griffith Raptors Membership Form
Name
*
First Name
Last Name
Gender
*
Male
Female
Other
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Email
*
example@example.com
Mobile Number
Please enter a valid phone number.
Format: 0000000000.
Are you a Griffith student?
*
Yes
No
Student number?
Payment
*
prev
next
( X )
Student Membership
$7.00 AUD
$
7.00
AUD
Membership
$10.00 AUD
$
10.00
AUD
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Submit
Should be Empty: