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 StreetMelbourne 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 - $25 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 $25
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.Renewals are subject to credit card approval.
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 and returning
to the Club
Your membership contact information.
