Clubs

Membership Category:*

Title:

First Name:*

Last Name:*

Date Of Birth:*

Sex:

Email:*

Alternate Email1:

Alternate Email2:

Address:

Suburb:

Country:

State:

Post Code:

Home Phone:

Mobile:*

Address:*

Suburb:*

Country:

State:*

Post Code:*

Work Phone: Ext:

Fax No.:

I agree to photographs being taken and used by the Club:*

Yes

I would like to claim a reimbursement under the NT Sports Voucher Scheme:*

Yes

NT Sports Voucher No:

NT Sports Voucher Expiry Date:

Membership categories

Junior – Under 18 years as at 1 January

Senior – 18 years and over as at 1 January

Non-Competitive – Membership access to training/clinics/social/volunteer duties, but excluding competition at events