Membership Form (New & Renewals)

(10% off bar & bistro, birthday voucher & other exclusive benefits)

Application Type - please choose one

If renewal, please enter your membership number

First name

Last name

Birthday

Day

Month

Year

Phone

Address including post code (no PO boxes)

Occupation

Membership Type (1st Jan - 31st Dec)

1 Year $10

2 Years$20

3 Years$25

How would you like to receive your new card?

I'll pick up on my next visit

Please post my card

Date picker

Photo ID (new applications won't be processed without photo ID)

Please upload an image of your current driver's licence, or other photo ID.

Signature

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