MEMBERSHIP APPLICATION

Instructions:

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 Street Melbourne 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 30/6/2007.

Information needed for your membership application. spacer
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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
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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.