Bribie Island Country Music Club

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BRIBIE ISLAND COUNTRY MUSIC CLUB

RENEWAL FORM

(Print This Form and submit it to the treasurer or secretary with the fee prescribed below)

All Information should be supplied to keep our database up to date



NAME:-----------------------------------------------------------------------------------------


ADDRESS:--------------------------------------------------------------------------------------


  : --------------------------------------------------------------------------------


                 :------------------------------------------------------------------------


PHONE    :--------------------------------------MOBILE------------------------------------------


D0B          :-------------------------------------EMAIL-------------------------------------------

           DOB Year is not required. We want your birthday!


NEXT OF KIN INCASE OF AN EMERGENCY


NAME      :--------------------------------------------------------------------------------------


PHONE N0:----------------------------------------

Annual Fee $10 Membership becomes renewable on the 1st October each year.

 

APPLICANT SIGNATURE:----------------------------------------------DATE:---------------------------

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Office Use Only:- Receipt No.___________________    Date___/___/___