Club Membership Registration Form

Complete the registration form below to sign up and please make immediate payment using the ref SUBS. Please do not combine with any other payment. Bank details are below.
Name*

First NameLast Name
E-mail
Address:

Street Address

Street Address Line 2

CityState / Province

Post codeCountry
Birth Date

DayMonthYear
Phone Number

Area CodePhone Number
Mobile no
Membership Type

Working Member (able to contribute time)Financial Member (unable to contribute time)
Working Member Prices*

Junior $45 Person between seven & sixteen in the year of application or still at schoolStudent $45 Person in full time tertiary education (proof required)Senior $75 Person over the age of sixteen & not at schoolFamily $150 One or both spouses and their children who comply to junior catCouple $130 Adult couple at same address
Financial Member Prices*

Junior $45 Person between seven & sixteen in the year of application or still at schoolStudent $45 Person in full time tertiary education (proof required)Senior $175 Person over the age of sixteen & not at schoolFamily $350 One or both spouses and their children who comply to junior catCouple $330 Adult couple at the same address
Family member 1

First NameLast Name
Birth Date 1

DayMonthYear
Family member 2

First NameLast name
Birth Date 2

DayMonthYear
Family member 3

First NameLast Name
Birth Date 3

DayMonthYear
Family member 4

First NameLast Name
Birth Date 4

DayMonthYear
Family member 5

First NameLast Name
Birth Date 5

DayMonthYear
Membership fee
Were you a member of the club last year ?*

YesNo
Amount to pay
Payment type

Online banking (ref "subs" your surname & initial) 06-0901-0026574-00
Where did you hear about us?

A Friend or colleaugeGoogleFacebookAdvertOther
Please select the mountain activity you are joining for

Skiing/bordingHang gliding/paraglidingMountain bikingOther
Please describe your activity
Should be Empty: