Membership Form

Your Contact Details
First Name *
Last Name *
Email Address *
Mobile *
Landline
Address Line 1 *
Address Line 2
Suburb *
City *
Postcode *
Country *
Membership Application
Membership Type *
Method of Payment *
Payment Date *
Total Membership
Would you like to make a Donation
Donation Amount
Total Payment *
Note: Bank Account Number 03-0502-0170202-00
From time to time you details may be provided to parties related to the club in order for them to provide you with ways to improve the value of your Membership. Please indicate if you do not want to receive these communications.
Your Relationship to the Club
Did you play for the Axemen *
Team
Start Date
End Date
Have you held a position at the club? *
Role
Start Date
End Date
How else do You support the Axemen? *
Teams
Start Date
End Date
Ways in which you can help
Would you like to support the club on the field?
Please indicate how:
Would you like to support the club off the field ?
Please indicate how:
Would you like to sponsor an area of the Club that is of interest to you?
Please indicate how:
150th Celebrations
Are you intending to be at the 150th Celebrations in 2020?
Would you like to receive updates on planned activities?
Any other comments


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