5 Year Membership Application


Membership Details

Prefix (required)

First Name (required)

Last Name (required)

Date of Birth (required)

Mobile Number (required)

Phone Number (required)

Email Address (required)


Address

Street Address (required)

Suburb (required)

State (required)

Postcode (required)

Tick if postal address same


Postal Address

Street Address (required)

Suburb (required)

State (required)

Postcode (required)


Staff Referrals

Name of Redcliffe Leagues Club Staff member who has referred you (if applicable)

I hereby certify that I am over eighteen (18) years of age. I will faithfully observe all rules and by-laws of the Club. I understand that from time to time, Redcliffe Leagues Club will communicate with me using information provided on this membership application form and from member loyalty systems, as per the Club’s Privacy Policy. I understand that I can opt out of communications at any time by informing reception staff.

I understand that I will need to collect my membership card from the Reception of the Redcliffe Leagues Club and that I will need to present valid photographic identification.