Direct Debit Request
Wonthaggi Country Club
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Select Your Membership Type
*
Please Select
7 Day $77.09
5 Day $72.92
Senior $72.92
Country $68.75
Under 25s $45.84
Under 18's $17.5
Subject to Category Conditions
Application Type
*
Existing Member
New Member ($60 joining fee added to the first payment only)
Back
Next
Payment Type
Credit Card
Bank Account
BSB
Account Number
Account Name
Back
Next
Wonthaggi Country Club Staff
Will be in touch with you to confirm your request after you complete the submission.
Signature
Continue
Continue
Should be Empty: