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.
A receipt will be sent to you. Click
here to print this page
There are three
types of membership available:
Metropolitan membership - $75.00 p.a. (Area
covered by Melbourne Telephone Directory) Country membership - $37.50
p.a.(Interstate and overseas
applicants qualify as country members)
Concession membership - $37.50 p.a.
Please remember to complete all the box marked with a *
Your
membership contact information.
Member
no:
*Your
name:
Mailing address
:
Suburb:
Postcode:
State:
Phone (a/h):
(work):
Mobile:
Email:
Member type:
Metroplitan $75.00
Country $37.50
Consession $37.50
Your payment details
Payment by:
Cheque:
Credit Card:
Card type:
(all major cards accepted)
Card number:
Expires:e.g.(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
renewal type requested.Renwals
are subject to credit card approval.
Your
membership contact information.
