One Year $9 
Three Years $24 
*Full Name: ____________________________________________________________________
*Address: ______________________________________________________________________________________________
____________________________________ *Post Code: _______________________________________________________
*Telephone: Home:
(____) _____________________________________________________________________________
(____) _____________________________________________________________________________
*E-Mail Address: _________________________________________________________________________________________
*Occupation: ____________________________________________________________________________________________
*Date of Birth: (dd/mm/yyyy): ______________________________________________________________________________
*What is your preferred method of contact?:
 Email  Mail  SMS/Mobile
*In accordance with the Registered Clubs Act NSW, this information must be provided and accurate.
Have you been a member of the Demo Club previously?
Are you a member of any of our sponsored Clubs?
 YES  NO
 St Joes Soccer Club
 North Football Club
 Central Football Club
The Barrier Social Democratic Club Ltd is subject to the provisions of the Privacy Act 1988. The personal information provided by you on this
application and attached documents will be used to process your membership application. Failure to provide all the requested information may result in
your application being rejected. You have a right to access and correct 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 your placing your membership card in a gaming machine or other
Club machine (excluding ATM’s), 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 services and promotions.
Do you wish to receive*:
Marketing material to keep up-to-date with what’s happening in the Club, information about our Promotions and Services and
information regarding Gaming Promotions?
 YES  NO
An Annual Financial Report?
 YES  NO
If YES to any of these options, what is your preferred method of delivery:
 Postal Mail
 E-Mail  SMS
*Please note, that if you supplied an e-mail address on this application, any marketing or information will be passed along to that address electronically.
Would you like to auto-renew your membership with points accumulated when renewals are due?  YES  NO
By signing this application form, it is declared that:
I am over the age of 18 years, my date of birth as provided above;
I have read and understood the Privacy Statement as outlined above;
All details on this form are true and correct.
SIGNATURE: ________________________________________
DATE: ____________________________________________
Membership No: _____________ Receipt No: ____________ Amount Taken: ______________
Identification No: _______________
State: _______
Computer Entry: 
Card Issued: 
Exp. Date: ____________ ID Type: ___________ Staff Signature: ___________ Date: ___________