Name

Address

Telephone (H)
Telephone (W)
Telephone (M)

Email

Date Of Birth / / (dd/mm/yy)

I wish to purchase A Membership ($120.00) OR
  A Season Pass ($120.00)

I wish to pay Online with a credit card or PayPal OR
  By Cheque or Money Order

If you wish your name to be entered in the club’s Register of Members, to be eligible to vote in club meetings, and to have access to Member benefits, please complete the sections below.

I (name and occupation), of (address) desire to become a member of the Melbourne Ice Inc.

In the event of my admission as a member I agree to bound by the rules of the Association for the time being in force.

I agree to receive correspondence and notices from the Association by email. I accept the above.