Membership Renewals

• Step 1: Personal details

• Member No#*
• Title
  MrMrsMsMissDrProfessorThe
• Name*
  FirstLast
• Preferred Postal Address (street or PO Box)*
  Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountry
• Phone (Home)*
• Phone (Work)
• Phone (Mobile)
• Email*
  Enter EmailConfirm Email
• Date of birth*

• Step 2: Interests

• Please tick your major areas of interest
  • Fine Dining
  • Health & Fitness
  • Skiing & Lodge
  • Dancing, Music & Entertainment
  • Wine Appreciation
• Would you like to receive email newsletters on special offers and events?*
  • Yes
  • No
• Tick if you would prefer to receive the Club magazine via post rather than email
  • Yes

• Step 3: Acknowledgements

• Declaration*
  • I declare that I am over the age of 18, have provided photo identification and that the information in this application is all true, complete and correct, and before signing this application, I received an opportunity to read and consider the Club’s Rules and the Club’s Privacy Policy.
• I acknowledge and agree*
  • That any personal information in this application form will only be used, stored and disclosed in accordance with the Club’s Privacy Policy and if accepted as a Member of the Club, I will be bound by the Club’s Rules and By-laws.
• Read our Privacy Statement.

• Step 4: Renew Membership

• Membership type to renew*
  • Life Renewal
  • Gold Renewal
  • Silver Renewal
  • Social Renewal
• Are you an existing Fitness Member?*
  • Yes I am an existing Fitness Member
  • No
• Would you like to apply for Membership in our Fitness Centres?*
  • Yes
  • No
• New Fitness Membership (available for Life, Gold and Silver Members only)*
  • New Annual Fitness Centre Fee
  • New 6 Month Fitness Centre Fee
  • New 3 Month Fitness Centre Fee
• Plus, if required (available for Life or Gold Members only)
  • Renew Annual Esperanto Club Fee
• Tick if you wish to apply to renew your
  • Fitness Centre Locker (fee $72.50)
  • Snooker Locker (fee $61.50)
• Total Payment
  $ 0.00
• Comments
  This field is for validation purposes and should be left unchanged.