HGC Membership Form

If you are renewing your membership please enter your member number : membership #

(Otherwise, tap Next.)

Application TypePlease select one.

New Member

Renewal

Name* This field is required.

First Name

Last Name

Birth Date:* This field is required.

Address:* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Mobile Phone Number

Please enter a valid phone number.

E-mail Address* This field is required.

Are you a member of one or more of our Community Groups?Tick one, more or none. Tap Next when done.

ACT Eight Ball Association

ACT Junior Rugby Union

Australian Deer Association

Australian Electric Vehicle Association

Austrian Choir Canberra

Canberra & District Aquarium Society

Canberra Blues Society

Canberra District Ducati Club

Canberra Men's Choir

Canberra Swiss Club

Canberra Region Beekeepers

Nuline Dance Club

Probus

Social Dance Club

U3A

Welsh Society of Canberra

Woden Community Services

Canberra Rowing Club

Community Services #1

Das Zentrum

Eurogames

The Canberra Burly Griffins Buhurt Group

The Harmonics

Other

Signature(You can leave this for when you're physically in the club.)

Clear

Membership Options* This field is required.Tick the appropriate box.

My Bag

SOCIAL MEMBER — 1 YearEarly access to news, promotions and discounts.
$5.00AUDEdit
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FULL MEMBER — 1 YearGrants access to board information and voting rights, on top of early access to news, promotions and discounts.
$10.00AUDEdit
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SOCIAL MEMBER — 3 YearsEarly access to news, promotions and discounts.
$12.00AUDEdit
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FULL MEMBER — 3 YearsGrants access to board information and voting rights, on top of early access to news, promotions and discounts.
$25.00AUDEdit
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Credit Card

First Name

Last Name

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HGC Membership Form