Application for New Membership

Application for New Membership
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

SuburbState / Province

Postal / Zip Code
Phone Number*
E-mail*
Membership
Please note that membership is valid until the 31st of December this year, except if you join in November or December. Then your membership will carry over to December 31st next year.

To enquire about other types of membership contact info@mud.org.au

External Members must be nominated by an existing Murdoch Uni Staff or Student member.
Membership Prices*
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Staff$40.00AUD

Select month of joining
Item subtotal:$0.00AUD

Student$40.00AUD

Select month of joining
Item subtotal:$0.00AUD

Alumni$40.00AUD

Select month of joining

External Membership$60.00AUD

Select month of joining
Item subtotal:$0.00AUD
Further Comments
Student or Staff Number*
Students or Staff Only
Nominated by (existing Murdoch Uni member)*
External only
Conferral Year*
Alumni only
Certification Details
Are you a qualified diver ?*

YesNo
Certification Number*
Level of Qualification*
Club Information
How Did You Find Us?*

Word of MouthInternetFacebookMarket Day StallNotice BoardOther
I would like to receive regular emails and event updates from Murdoch Diver's Club*

Yes pleaseNo thank you
Payment
We prefer payments be made by bank transfer, but cash payments can be arranged.

Bank Transfer Details:

Name: Mur. Uni. Divers Club (WA) inc

BSB: 806-036

Account: 603608941

Please state 'Membership' in the description.
Declaration
View the Murdoch University Diving Club Constitution

View Murdoch University Diving Club's Safety Regulations
I have read and agree to abide by the Club's safety regulations at all times as set out by the Club's constitution.
Add a photo of your dive certification *

Upload a File

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Add a photo of your student or staff card*

Upload a File

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Note: The Dive Club does not provide insurance for members. It is the member's responsibility to seek insurance if they require it.
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Application for New Membership

Membership

Certification Details

Club Information

Payment

Declaration