I agree to the Brisbane Heat Membership Terms and Conditions as outlined on: brisbaneheat.com.au/membership
S T A N L E Y S T
V U L T U R E S T
MA
I N S
T1: Tell us about yourselfPlease complete this entire section and Part Two if other people are joining with you (individuals or family members). Note: we are unable to process your membership if details are missing.
Title First Name Surname
Postal Address
Suburb State Postcode
Phone (H) Phone (M)
Email Gender: M / F
Date of Birth Local Cricket Club
2: Tell us about anyone else joining with youMember #2 Title First Name Surname
Gender: M / F Email Date of Birth
Member #3 Title First Name Surname
Gender: M / F Email Date of Birth
Member #4 Title First Name Surname
Gender: M / F Email Date of Birth
Member #5 Title First Name Surname
Gender: M / F Email Date of Birth
3: Select your Membership
KEY MEMBERSHIP ADULT QTY CHILD QTY CONC QTY FAMILY(2A+2C) QTY FAMILY
(2A+3C) QTY FAMILY(2A+4C) QTY TOTAL $
Luxe Lounge $380 $380 $380 N/A N/A N/A
Hot Spot $240 $240 $240 N/A N/A N/A
Gold Reserved$130 $115
$50 $40
$90 $70
$310 $270
$330 $285
$360 $310
Boundary General Admission $90 $35 $65 $215 $245 $265
Upper General Admission $90 $35 $65 $215 $245 $265
Supporter $30 N/A N/A N/A N/A N/A
Total $
Refer to map below for seating locations
Please note: • All prices are GST inclusive • Please refer to the Brisbane Heat website for Concession eligibility conditions • Child pack not applicable to Supporter memberships.
5: Payment OptionsWe accept MasterCard, VISA, cheque or money order payments. All cheques are to be made payable to Brisbane Heat.
5.1: My Payment Details
Credit Card*
First Name
Credit Card Number
Signature
CVV
Expiry Date
Last Name
4: Seating Request (for Gold Reserved Memberships only)
Please indicate any seating preferences below i.e. to be seated near an aisle or next to someone who is joining via a separate form:
Luxe Lounge
Hot Spot
Gold Reserved
Boundary General AdmissionUpper General Admission
M E M B E R S H I P A P P L I C A T I O N
I G N I T E T H E P A S S I O N b r i s b a n e h e a t . c o m . a u / m e m b e r s h i p
Online: www.brisbaneheat.com.au - VISA or MasterCard only.
Phone: 1800 GO HEAT (1800 464 328) – VISA or MasterCard only.
In Person: visit us at Queensland Cricket - 1 Greg Chappell Street, Albion QLD between 9am and 4.30pm, Monday to Friday (VISA, MasterCard, cheque, money order, EFT, or cash accepted).
By Mail: please send completed form with payment to: Brisbane Heat Membership, PO Box 575, Albion QLD 4010 (VISA, MasterCard, cheque or money order accepted).
VISA
Total amount due: $
MasterCard Money order Cheque EFT
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