Membership - Swiss Club of WA

Swiss Club of WA - Membership

Question Title

* 1. Adult 1

First Name

Surname

Date of birth (dd/mm/yyyy)

Email address

Mobile number

Swiss Citizen (yes or no)

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* 2. Adult 2

First Name

Surname

Date of birth (dd/mm/yyyy)

Email address

Mobile number

Swiss Citizen

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* 3. Child 1

Name

Date of birth (dd/mm/yyyy)

Swiss Citizen

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* 4. Child 2

Name

Date of birth (dd/mm/yyyy)

Swiss Citizen

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* 5. Child 3

Name

Date of birth (dd/mm/yyyy)

Swiss Citizen

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* 6. Child 4

Name

Date of birth (dd/mm/yyyy)

Swiss Citizen

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* 7. Contact

Street Address

Suburb

State

Post Code

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* 8. Annual Membership Fees for 2021/2022

Couple/Family (incl. children up to 18 years): $75.00
Single Person: $50.00
Couple/Family unwaged: $55.00
Single person unwaged: $40.00
*Unwaged means: Pensioner/Concession Card holders or full time students.

Bank details for the ANZ bank account
BSB 016255
Account 427568658
Description 'Surname Membership' eg ... Smith Membership