Membership Form
Official Liverpool Supporters Club Gauteng
Membership Form 2026/27
Name (Member 1)
First Name
Last Name
Name (Member 2)(complete this if you are applying as a couple)
First Name
Last Name
Email (Member 1)
example@example.com
Email (Member 2) (complete this if you are applying as a couple)
example@example.com
Phone Number (Member 1)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Member 2)(complete this if you are applying as a couple)
Please enter a valid phone number.
Format: (000) 000-0000.
Membership status (Member 1)
New
Renewal
Membership status (Member 2)(complete this if you are applying as a couple)
New
Renewal
Membership number (Member 1) (if a renewal)
Membership number (Member 2) (if a renewal)
My Products
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( X )
Premium membership (single)
350.00 ZAR
350.00
ZAR
Quantity
1
2
3
4
5
6
7
8
9
10
Premium membership (couple)
650.00 ZAR
650.00
ZAR
Quantity
1
2
3
4
5
6
7
8
9
10
Premium membership (U18)
150.00 ZAR
150.00
ZAR
Quantity
1
2
3
4
5
6
7
8
9
10
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