1. Please print out this form first (do not enter details before printing) 2. Complete the form 3. Fax to (03) 9670 5153 or post to Celtic Club, 320 Queen StreetMelbourne
3000.
Click here to print this
page
We will
confirm your application by mail. Your application will be presented at the
next full committee meeting (normally the last Tuesday of each month).
Metropolitan membership $50.00 p.a. (Area covered by Melbourne Telephone Directory)
Country membership - $35.00 p.a. (Interstate and overseas applicants qualify
as country members.)
Concession membership - $25.00 p.a.
Please
note: Membership will run to 30/6/2008.
Information needed for your membership application.
Your
first name:
Your
last name:
Mailing
address:
Suburb:
Postcode:
State:
Country:
Phone
(a/h):
Phone
(work):
Mobile:
Email:
Occupation:
Celtic Interest:
My interest in joining the Celtic Club is:
Nominator:
(member of Celtic Club)
Should you not have a nominator your application will be referred to
the President, Mr Brian Shanahan, for consideration.
Overseas applications at the discretion of the committee.
Nominator's
contact details:
Member
type:
Metroplitan $50, Country $35, Consession $25
If you wish to be in our birthday club
please supply your birthday.
Birthday:
(year optional)
Your payment
details
Card type:
(All
major cards accepted)
Card number:
e.g. 1234 5678 9012 3456
Expiry date:
e.g. month/year (03/02)
Name on card:
Card ID no:
American
Express cards only
I authorise
the Celtic Club to debit my credit card with relevant amount for the
membership type requested. All applications are
subject to credit card approval
I desire to become a member of the
Celtic Club Incorporated. In the event of my admission as a member, I
agree to be bound by the rules of this Association for the time being in
force.
Our Club’s Annual Report will be
available each year to members via our Website. Should you require a
written copy please notify us by checking the box.
