Online Membership Form 2017 - 2018 Membership Our competition season runs from May 2017 – April 2018. Membership includes monthly comp and bbq, club merchandise and our annual presentation night. We surf 10 out of 12 months on the last Sunday of each month. Name* First Last NicknameOccupation*Date of Birth* DD MM YYYY Contact InformationAddress Street Address City State Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Home PhoneWork PhoneMobileEmail* Membership OptionsFor one season (Non refundable) includes monthly comp fees, annual dues and presentation nightMembership Fees*SENIORS (over 18) $180JUNIORS (under 18) $100FAMILY (1x senior + 1x junior) $250Additional Family MemberName of Additional Family Member First Last Date of Birth DD MM YYYY Additional Member Email Address T's and C'sI hereby apply to become a fully paid member of the Curl Curl Longboarders Inc for the 2016/2017 season. I agree to abide by the rules of the natural cause or otherwise, injuries, illness, or (death) ill health whatsoever and howsoever arising from my participation or presence at the Club activities. I am aware that I am under no obligation to enter the surf and may withdraw from competition at any time if I consider the conditions indemnify all other club members from any liability, loss or damage associated with my participation in Club activities.Terms and conditions acceptance*Yes, I have read and accepted the terms and conditions listed aboveYesParent Guardian ApprovalBecause you are under 18 this form needs to be approved by a parent or guardian. Has this form been approved? Yes PaymentSenior MembershipSENIORS (over 18) $180 Price: $ 180.00 Juniors MembershipJUNIORS (under 18) $100 Price: $ 100.00 Family MembershipFAMILY (1x senior + 1x junior) $250 Price: $ 250.00 Total $ 0.00 The only thing pending is for us to receive your payment. You can pay us through your bank account with a Direct Deposit to: Bendigo Bank: Freshwater Branch Account Name: North Curl Curl Longboarders Inc Account Number: 149475402 BSB: 633 000 All the above content will also be emailed to both you and the club on submission of this form.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.