Membership Renewals Step 1: Personal detailsMember No#*TitleMrMrsMsMissDrProfessorTheName*FirstLastPreferred 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.YemenZambiaZimbabweCountryPhone (Home)*Phone (Work)Phone (Mobile)Email*Enter EmailConfirm EmailDate of birth* Step 2: InterestsPlease tick your major areas of interestFine DiningHealth & FitnessSkiing & LodgeDancing, Music & EntertainmentWine AppreciationWould you like to receive email newsletters on special offers and events?*YesNoTick if you would prefer to receive the Club magazine via post rather than emailYesStep 3: AcknowledgementsDeclaration*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 MembershipMembership type to renew*Life RenewalGold RenewalSilver RenewalSocial RenewalAre you an existing Fitness Member?*Yes I am an existing Fitness MemberNoWould you like to apply for Membership in our Fitness Centres?*YesNoNew Fitness Membership (available for Life, Gold and Silver Members only)*New Annual Fitness Centre FeeNew 6 Month Fitness Centre FeeNew 3 Month Fitness Centre FeePlus, if required (available for Life or Gold Members only)Renew Annual Esperanto Club FeeTick if you wish to apply to renew yourFitness Centre Locker (fee $72.50)Snooker Locker (fee $61.50)Total Payment$ 0.00CommentsThis field is for validation purposes and should be left unchanged. *2Payment are made using PayPal. PayPal is a secure payment system that enables you to pay safely online using your credit card, debit card, bank account or PayPal account. To read more about the PayPal payment system, visit the PayPal website.