Exmouth Game Fishing Club Membership Form for Year 2012

Contact Information:

First Name (required):  

Family Name (required):  

Postal Address:

Telephone (H):  

Telephone (W):  

Mobile:  

Email:  

Method of Payment:
 Direct Credit Cheque Credit Card In Person

If paying by Credit Card please complete and sign a 2012 Membership Application Form (below) and post to Kathy Ryan, PO Box 121, Exmouth, 6707 or fax to 08 9949 1314.

Type of Membership:
 Family (2 Adults & Dependant Children Under 16) $240 Adult $120 Junior $60 Adult Social (not fishing) $90 Family Social (not fishing – 2 Adults & Dependant Children Under 16) $180 Nomination Fee (applies if you are not a current 2011 financial member) $50

Junior Membership Date of Birth:  

Additional Information:

If you have chosen family membership, please fill in extra details:

2nd Adult Full Name:  

1st Child Full Name:  
DOB:  

2nd Child Full Name:  
DOB:  

3rd Child Full Name:  
DOB:  

Comments:

Terms & Conditions:
 I agree to abide by Rules and Regulations set out by the EGFC and acknowledge this membership is only valid until 31 December 2012. Recognition of points for end of season trophies/tournaments will only be awarded from date of payment received.

Signed (Your Name):  

Date:  

For more information please contact Kathy Ryan membership coordinator 9949 1086.

Cheque/Money Order and form to be sent to Attention: Memberships EGFC PO Box 121 Exmouth WA 6707, or email form to treasurer@egfc.com.au and direct credit to EGFC Westpac BSB 036 180 Acc# 360 218 and state your full name and Membership 2012 with deposit, or pay direct at Bluewater Tackle World Exmouth.