Bribie Island Country Music Club

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Bribie Island Country Music Club

(Print this form and bring it to any of the events in the event calendar.)

Membership Application


NAME______________________________________________________________________________________________________________________




ADDRESS___________________________________________________________________________________________________________________



Phone_____________________________________ Mobile_______________________________________



Email________________________________________________________________ DOB____/_____/_____




Next of Kin (In Case of Emergency)



NAME___________________________________________ Phone No.______________________________________



Annual Fee $10 membership becomes renewable on the 1st October Each Year.



APPLICANT SIGNATURE_____________________________________ DATE _____________________________




PROPOSER_________________________________________ SIGNATURE_______________________________



SECONDER________________________________________ SIGNATURE________________________________



Approved/Rejected (Signature and Date)_______________________________________________________



$___________Received by________________On _____/____/_____ Receipt No. _______________ Membership No.___________________