Temporary Membership Application Form

Temporary Membership Application Form
Full Name*

First NameLast Name
Address*

Street Address

Street Address

SuburbPost Code

Post Code
Ph / Mobile*
E-mail*
example@example.com
Required Period of Temporary Membership
Start Date*

DayMonthYear
Date
End Date*

DayMonthYear
Date
Eligibility

All Applications are subject to acceptance at the sole discretion of the GCS&BC

All applicants must:
• Pay the required temporary membership fee (refundable if not accepted).
• Be of sound mind, good character and repute.
• Abide by the constitution, rules, policies and the directions of the GCS&BC
as posted on the Club website and/or displayed in the Club.
• Abide by the access and facilities usage instructions provided by the GCS&BC.
I acknowledge and agree with the eligibility conditions.*

I agree
Membership Fees
Amount Paid*
Payment Method*

Payment in CashBank Transfer to: The Gold Coast Snooker & Billiards Club Inc -Bank account - BSB 484-799 Acct No. 071586971
Applicant Declaration

• I have read, understood and agree with the eligibility conditions above.
• I have read, understood and agree with the Waiver and Release of Liability
posted on the Club website.
• I solemnly declare that the statements made in this membership application are
to the best of my knowledge true and accurate.
Signature of Applicant*

Powered by Jotform SignClear
Date*

DayMonthYear
Should be Empty: