Membership Renewal

Associate Member*

50 Year $110 3 Year $10 1 Year $5

Member No*

Title*

Mr Mrs Miss Ms

First Name*

Last Name*

Address*

Postcode

Date Of Birth*

Phone No

Mobile No

Email*

Occupation*

If You Are Currently in the Mortality Fund Please Complete the Following:

Name of Beneificiary

Address

Relationship to Member

Language Spoken At Home

Preferred Method of Contact

Mail Email Phone

Declaration

I declare that the information I have provided in this application is true and complete. I agree that I am bound by, and will comply with, the Club's Constitution, By-Laws and rules as amended from time to time.

Privacy

I concent to the collection, use and disclosure of my personal information in accordance with the Club's Privacy Policy. I understand that the primary use for the collection of this information is so that Club Rivers can communicate with me. From time to time, other companies in which Club Rivers has an ownership interest may also advertise good and services to me using this information. I acknowledge that on Club's Privacy Policy is available to the me online at www.clubrivers.com.au, on request at the Club, or by calling 02 9533 3144 to have a copy of the policy posted or emailed to me.

I wish to receive direct mail material, promotional offers, the club magazine, and general information from Club Rivers (Riverwood Legion & Community Club).

I wish to receive Club Rivers Annual Report.

I wish to receive gaming machine specific promotional information.

Payment Details

Card Holder Name *

Credit Card Number *

Expiry Month *

Expiry Year *

Card Ccv *

Membership Renewals