Become A Member

Comments

This field is for validation purposes and should be left unchanged.

New or Existing Member(Required)

New Member

Existing Member (Renewing)

Membership Type(Required)

Social Member (1 Year) - $5.00

Social Member (3 Years) - $10.00

Name(Required)

Prefix First Last

Address(Required)

Street Address Suburb State / Province / Region Postal Code Country

Phone(Required)

Date of Birth(Required)

Email(Required)

Declaration

I hereby make application for membership with the Palm Beach Currumbin Rugby Union Club.

I hereby certify that I am over the age of 18 years (proof of age required for new members)
I have / have not (delete not applicable) had my membership suspended / terminated in a registered club or other licenced premises over the past three (3) years for any behavioural / establishment code of conduct breaches
If yes, please specify
I acknowledge that acceptance as a member is subject to consideration and approval or otherwise by the Management Committee of the Palm Beach Currumbin Rugby Union Club.
I acknowledge that if I make a false or misleading declaration as part of the membership application process, the Palm Beach Currumbin Rugby Union Club reserves the right to suspend/cancel/terminate my membership at their absolute discretion.
I understand that if granted membership of the Palm Beach Currumbin Rugby Union Club I am required to abide with Club house rules and Code of Conduct requirements at all times whilst on club premises or representing the Club in any capacity.
Palm Beach Currumbin Rugby Union Club practices the responsible service of alcohol and any violation of the principle by a member may result in membership suspension / cancellation or termination.

Date(Required)

Signature(Required)

Please check that you have selected the correct membership type/category before continuing with payment.

Total

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name