Membership DetailsMember Number*Name* First Name Surname Address* Residential Address Town / Suburb Postal address (if different from above)Preferred contact numberEmail Address* Date of birth* Date Format: DD slash MM slash YYYY Occupation** In accordance with the Registered Clubs Act NSW, this information must be providedMembership RenewalMembership Renewal*One year Membership period (01/07/2019 – 30/06/2020) $ 5.00Five year Membership period (01/07/2019 – 30/06/2024) $ 20.00Additional InformationWhich of the following social media channels do you use? Facebook Instagram Twitter Snapchat YouTubeWhat types of food do you prefer? Steak Seafood Curry Italian Asian Mexican Buffet Carvery Homestyle OtherWhat is your preferred Major Prize (Over $10,000)? Cash Car Holiday Boat Caravan Camping Goods Whitegoods OtherWhat is your preferred minor Prize ($1000 or under)? Cash Club Voucher Gift Card Meat tray Appliance Advantage Card Loyalty Points OtherWhat type of entertainment do you prefer? Solo Duo Cover Band Tribute Band Open Mic New local talent Comedy OtherGaming: Player Activity statements are available upon request.Credit Card Payment (Security Ensured)Credit Card*American ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.