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MEMBERSHIP APPLICATION

COMPLETE AND PRESENT AT RECEPTION

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MEMBERSHIP(Required)

1 Year - $5

3 Years - $12

5 Years - $15

TITLE(Required)

MRS

MISS

Other

FIRST NAME(Required)

LAST NAME(Required)

DATE OF BIRTH(Required)

MM slash DD slash YYYY

EMAIL(Required)

MOBILE(Required)

MAILING ADDRESS(Required)

SUBURB(Required)

POST CODE(Required)

STATE(Required)

NSW

VIC

QLD

TAS

ACT

Consent

I confirm that I am over 18 years of age and agree to abide by the constitution, by-laws and all other rules of the club. All information above is true and correct and I have read and understood the terms and conditions available at reception.

AFFILIATE CLUB *

Banks Bulldogs Football Club

Banks Bulldogs Netball Club

Darwin Cricket Club

Nightcliff Rugby League Football Club (Nightcliff Dragons)

Wanderers Football Club

Other

* Verification of affiliate club membership required upon collection of Silks membership card at reception.

SIGNATURE(Required)

DATE(Required)

MM slash DD slash YYYY

I don’t want information about member discounts, loyalty promotions or birthday rewards.

CAPTCHA

DICKWARD DRIVE, FANNIE BAY NT 0820
GPO BOX 589, DARWIN NT 0801
(08) 8922 4929

Website By Daily Press Group | 2020 Silks Darwin

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