VOSTOK Volleyball Club - Individual Member Registration Form 2019

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Submission of this form is an application for membership of VOSTOK Volleyball Club Only.

Membership applications for players under 18 years of age must also be confirmed by the applicant’s parent or legal guardian.

Email *

Please select the membership category which you are applying for in 2019 *

About Me

First Name *

Surname *

Gender *

Home Address *

Suburb *

Postcode *

Primary Phone Number *

Other Number

E.g. Home, Work or Mobile

Email Address *

Date of Birth *

YYYY

Are you of Aboriginal or Torres Strait Islander descent? *

Yes

Member Declaration *

I have read, understood, acknowledge and agree to the above declaration including the warning, exclusion of liability, release and indemnity. I acknowledge that if my application for membership is successful I will be entitled to all benefits, advantages, privileges and services of SVNSW and VA membership.

Required

Parent/Guardian Declaration

Where the applicant is under 18 years of age this form must also be confirmed by the applicant’s parent or legal guardian.

Parent/Guardian Full Name

Parent/Guardian Email address

Parent/Guardian Phone number

Image Permission

I do not consent to the use of my child's image by Vostok Club as described in Clause 12 of the Membership Declaration

Parent/Guardian Declaration

I, the above named, am the parent or guardian of the applicant. I expressly agree to be responsible for the applicant’s behaviour and agree to personally accept the conditions set out in this membership application and declaration including the provision by me of a release and indemnity in the terms set out above.

Are you interested to play at Vostok Cups?

Yes

Maybe

Clear selection

Are you interested to play at SVL (Sydney Volleyball League) every Sunday from 02 June till 22 September @ SOP *

Yes

Maybe

Are you interested to play at SVNSW State Cups on? *

06-07 April @ Central Coast

04-05 May @ Newcastle

25-26 May @ Illawarra

03 August @ Sydney Olympic Park

27 October @ Sydney Olympic Park

Required

Payment

Please select your preferred method of paying the 2019 Membership Application fee *

CASH or CHQ made payable to VOSTOK VOLLEYBALL

EFT direct to Vostok Bank Account

Vostok Club Bank Account Details

Account name: Vostok Volleyball Club
BSB: 062 213
Account number: 0090 1274
Reference: your full name

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms