BMOFA Membership Form – Bear Men Of Adelaide

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MEMBERSHIP APPLICATION FORM

BMOFA - New Registration & Renewal Membership

Step 1 of 3

0%

APPLICATION FOR:(Required)

New Member

Gift Membership

Renewal Membership

Registration Fiscal Quarters of(Required)

Q1 (July - September)

Q2 (October - December)

Q3 (January - March)

Q4 (April - June)

NEW MEMBERSHIP FEES Q1(Required)

Single

Concession

Couple

NEW MEMBERSHIP FEES Q2(Required)

Single

Concession

Couple

NEW MEMBERSHIP FEES Q3(Required)

Single

Concession

Couple

NEW MEMBERSHIP FEES Q4(Required)

Single

Concession

Couple

RENEWAL MEMBERSHIP(Required)

Single

Concession

Couple

Add an extra year

GIFT MEMBERSHIP Q1(Required)

Price:

*Memberships expire 30 June

GIFT MEMBERSHIP Q2(Required)

Price:

*Memberships expire 30 June

GIFT MEMBERSHIP Q3(Required)

Price:

*Memberships expire 30 June

GIFT MEMBERSHIP Q4(Required)

Price:

*Memberships expire 30 June

Price

*Memberships expire 30 June

Applicant Details

Name(Required)

First Last Preferred Name

Date of Birth(Required)

Email(Required)

MobilePhone(Required)

Home Phone

T-shirt Size

Partner Details

Partner Name(Required)

First Last Preferred Name

Partner Date of Birth(Required)

Partner Email(Required)

Partner Mobile Phone(Required)

Partner T-shirt Size

Donor Details

Donor Name(Required)

First Last Preferred Name

Donor Email(Required)

Donor Mobile Phone(Required)

Applicant Address

Address

Street Address City State / Province / Region ZIP / Postal Code Country

ADDITIONAL INFORMATION

I/we are interested in helping out at club events.

I/we are interested in joining the committee.

Consent(Required)

I/we agree to abide by the Bear Men of Adelaide Inc.

Constitution and policies available at www.bearmenofadelaide.com.au

Signature(Required)

PAYMENT(Required)

Bank Transfer

PayPal/Credit Card

Total

Direct deposit to Westpac Bank account:
Bear Men of Adelaide Inc.
BSB: 035 045
Account No: 227 268
*Please quote surname(s) as reference

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