Churchie OBA: Contact Information Form

Application for

Life Membership

I would like to join the Churchie Old Boys' Association as a Life Member and believe that I have the necessary qualifications for membership. If my application is accepted, I agree to abide by the rules and regulations of the Association, as bounded by its constitution.

On completion of this application form, you will be redirected to the payment page to pay the OBA Life Membership fee of $500. Once your form and payment have been received, your application will be considered for approval at the next meeting of the OBA Committee. These meetings are typically held on the third Monday of each month.

First Name:*

Last Name:*

Peer Year:*

Years at Churchie:*

From

To

Email Address:*

Mobile Phone:*

Unit Number:

Street Number:*

Street Name:*

Suburb:*

Postcode:*

State / Territory:*

Country:*

By submitting this form, you agree for your contact information to be shared between the Churchie Old Boys' Association and the Anglican Church Grammar School (Churchie).