Membership Application Form - Crescent Head Country Club

Crescent Head Country Club Limited
Ph: 02 6566 0268
1 Rankine St, Crescent Head, NSW 2440
email: [email protected] ACN: 001 037 707
APPLICATION FOR MEMBERSHIP
Mr/Mrs/Ms/Miss Given Names: .......................... …………….Family Name:……………………………………………………..
Mailing Address: ........................................................................................................................................ …………………….
Residential Address:……………………………………………………………………………………………………………………..
Phone - Home:…………………………Mobile: .... …………………………. Date of birth: ………………………………………...
Email: ………………………………………………………..
Occupation: .................................................. …………………….
Drivers Licence / Identification number ……………………………………….
Type of membership being applied for? (circle):
FULL
PENSIONER
Do you wish to receive marketing material and information about our promotions and services?
Yes
No
What is your preferred option regarding annual reports (tick one box only):
□ No annual report. □ Mail an annual report to me, please.
The club will provide any member with their own player activity statement in relation to Gaming Machines.
FALSE DECLARATION OF INFORMATION SHALL RENDER APPLICANT LIABLE TO NON ACCEPTANCE OF MEMBERSHIP
The Board may reject any applicant for membership without assigning any reason for such rejection.
Applicants under the age of 25 must attend an induction meeting before their membership will be approved.
I, the person correctly described above, would like to become a member of Crescent Head Country Club Limited, in
accordance with the Constitution, and agree to abide by the Rules, and By-laws of the club at all times, and have read the
Privacy Statement below.
Signature: ..........................................................
Date: ………………………………
*** PLEASE BE ADVISED THAT RECEIPT OF THIS MEMBERSHIP CARD IS PROVISIONAL UNTIL APPROVED BY THE BOARD OF DIRECTORS
AT THE NEXT MONTHLY MEETING. NEW MEMBERS ARE INELIGIBLE TO WIN MEMBERS DRAWS UNTIL SUCH TIME AS APPROVED. NON
ACCEPTANCE WILL BE NOTIFIED BY MAIL AND YOUR MEMBERSHIP FEE REFUNDED. THE MEMBERSHIP CARD MUST BE RETURNED TO
THE CRESCENT HEAD COUNTRY CLUB.
PRIVACY STATEMENT
The Crescent Head Country Club Limited (Club) is subject to the provisions of the Privacy Act 1988 and the Privacy and Personal Information Protection Act 1998. The personal information provided by
you on this application form and attached documents will be used to process your membership application. It is a requirement of membership that this application form is completed and failure to provide
all of the requested information may result in your application being rejected. You have a right to access and correct any of your personal information that the Club holds about you. The Club does not
usually disclose your personal information to any other organisation or person unless there is a legal requirement to do so. The Club may disclose your information to third parties that provide services
under contract to the Club. These contracts require the third party to keep your personal information confidential and secure. Your personal information, including information about you obtained as a
result of you placing your membership card in a gaming or other club machine (not ATM), may be used by the Club for marketing purposes to improve our services and to provide you with the latest
information about those services and any new related services and promotions.
CLUB USE ONLY
Identification details: ………………………………
Date: ……………………………………………….
Receipt # : …………………………………………
Amount Paid: ………………………………………
Joining Fee
Membership Fee
Golf
Bowls
Tennis
Fishing
Malibu
Netball
$10.00
$15.00
$105.00 + Joining Fee $25.00
$105.00 + Joining Fee $25.00
$105.00 + Joining Fee $25.00
$4.00
$4.00
$4.00
Total ( inc GST )
$
Membership Number: ............................... …….
Nomination: Approved / Rejected
Date Approved: ....................................................
Under 25 Induction needed Y / N
Completed: Y / N ( please circle )
Date of Induction meeting: …………………………………
Director Signature: ……………………………………………………….