Exmouth Game Fishing Club Membership Form for Year 2010

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 2010 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 2009 financial member) $50 5-Year Adult Membership $1000 Please select to contribute voluntarily to the Clubhouse Building Fund $30

Junior Membership Date of Birth:  

**The $1000 5-Year Adult Membership Category is to assist the EGFC with costs incurred from building the clubhouse. This limited offer is only available for 2010. All 5 year members will receive a certificate of appreciation. This offer hedges against possible future membership cost increases.

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 2010. 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 Kath Ryan membership coordinator 9949 1086 or, Jeni Gates, President on 08 9949 1315, fax 08 9949 1314 or mobile 0408 905 448.

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 2010 with deposit, or pay direct at Bluewater Tackle World Exmouth.