Snowboarding Australia

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MEMBERSHIP FORM
Tick the relevant Box below.

Membership Application !

DATE: ___/___/___

Membership Renewal !

APPLICANTS DETAILS: [PLEASE PRINT CLEARLY]

MEMBERSHIP NUMBER :..................

(if renewal or if applying for Associate membership please put your current AA Number above)

Mr/Mrs/Miss/Ms
Surname ......................................................... Given
Name(s).......................................................................
Residential Address:

.................................................................................................................................................................P
ost Code........................
Mailing Address (if different from Residential Address)

...................................................................................................................................................................
Post Code ........................

Telephone ........................................................Mobile .........................................

Email ..................................................................................................................................................

Date of Birth: .....................................

Membership Applied for:

Children 3-8

Gender : M /

Youth 9-19

Adult 20+

NAME AND SIGNATURE OF PARENT OR GUARDIAN IF APPLICANT IS UNDER 18

NAME (print) _____________________________________________ SIGNATURE

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