Membership Application Form

Full Name

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

PIN CodeCountry

Postal Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

PIN CodeCountry

E-mail*

Home Number

Format: 0000-0000.

Mobile*

Format: 0000 000 000.

YesNo

Membership Term*

One year membership$30AUD

Two year membership$50AUD

Payment Options

Pay by Direct deposit:

BSB: 032-372 Account Number #380047

Account Name: Saheli Club Incorporated

Reference: Your full name

I am over the age of 18 and wish to become a member of SAHELI CLUB Inc. I request that you enter my name on the Register of Members accordingly.To be bound by your constitution and any rules, including privacy policy, regulations or by-laws of the Club.I declare that my membership hasn’t been revoked previously.I understand that membership is non-transferable and fees are not refundable.I understand that membership needs to be renewed every year on the date of my anniversary with the required payment or else it will be revoked.I understand that I can cancel my membership anytime by putting in a written letter of resignation

Signature

Signature date

*Membership includes member, spouse and dependant kids. It does not include cost of the ticketed events which needs to be paid separately.