As it appears on your ID document:
Last name: ______________________________
Firsts name/s: ____________________________
Date of birth: ____________________________
Your preferred name or nickname? ___________________________________
Residential address as it appears on your Proof of Address:
Street address 1: ___________________________________
Street address 2: __________________________________
Contact phone number: _____________________
E-mail address: __________________
From the e-mail address above, e-mail a copy of your Identity Document, Proof of Residence and a full length photograph of yourself for our membership directory.
Have you read and do you accept our Private Membership Club Rules? Yes/No
List at least two current members who would recommend you:
If you don't know any members yet, please provide at least two other references, your relationship to them and their contact details:
List at least two others who you believe would make great members and their contact details:
Of which other clubs or organizations are you a member? Details and contact information.
Have you ever been charged with or convicted of a crime? If yes, provide details.