MEMBERSHIP APPLICATION &RENEWAL FORMMembership Number (if renewing)

Mr Miss Mrs Ms Other

First Name

Preferred Name (to appear on card)

Last Name

Date of Birth / / Male Female

Mobile Home

Email

Residen al Address

Suburb State Postcode

Postal Address (or as above)

Suburb State PostcodeI hereby apply for membership of Club Kilsyth and Club Ringwood. I declare that I am over the age of 18 years and agree to strictly abide by the Club’s Cons tu on and Bylaws (a copy is available at recep on) as amended from me to me and declare that the details on the Applica on are true and correct. I have read and

understood the Club Rewards rules and agree to be bound by them. Privacy Statement: In par cular I consent and agree to the disclosure to, and use of, personal informa on about me for the purpose of carrying out, marke ng, planning

and administra on of the Club Reward Program and to contact the applicant.

Signature of Applicant

Date / /

Membership Dura on1 year $10 3 years $25 5 years $35

Your membership will be due for renewal on the anniversary of the 1st of July.

Please complete form overleaf.....

Cnr Oban Road & Maroondah Highway Ringwood, Victoria 3134T (03) 9879 8733E enquiries@clubringwood.com.auwww.clubringwood.com.au

Cnr Canterbury & Colchester RoadsBayswater North, Victoria 3153T (03) 9761 4233E enquiries@clubkilsyth.com.auwww.clubkilsyth.com.au

Licensee: Kilsyth and Mountain District Basketball Associa on Inc.

MEMBERSHIP APPLICATIONJOIN TODAY FROM ONLY $10

PRIZES EVENTS REWARDS OFFERS

“see you at the club”

Your Guide to Club Membership

BENEFITSJoin Club Rewards and begin to earn the privileges of being a Club Member

ACCESS TO TWO GREAT DESTINATIONSClub Kilsyth and Club Ringwood

DISCOUNTED ENTERTAINMENTExclusive invita ons and save on cket pricing for most of our shows and events

LOYALTY POINTS Earn points for every purchase you make at the Club. Points can be used to purchase a range of products and entries into members draws

EXCLUSIVE PROMOTIONS & OFFERSEnjoy exclusive member promo ons including daily kiosk vouchers, the chance to win cash and other great prizes and give aways

COMPLIMENTARY BIRTHDAY OFFERSAutoma cally receive off ers on your birthday so you can celebrate with us

DISCOUNTS Members receive great discounts on selected food, beverage and func on room hire** Terms and Condi ons Apply

FOR JUST $10 MOST MEMBERS SAVE THE COST OF THEIR MEMBERSHIP IN THEIR FIRST VISIT

Gaming Machine Player Only (Government Requirement)The following ques on must be answered to allow your membership card to earn loyalty points accrued by playing gaming machines.I agree to receive my Player Ac vity Statement, in accordance with Victorian Government legisla on (please ck one box only)

Via Email Collect in Venue Via Mail

Membership of the Club Kilsyth and Club Ringwood Gaming Player is only available to individuals who are not subject to a current self exclusion deed in rela on to a gaming venue that has electronic gaming machines installed. If an individual who is a member of the Club Rewards Program becomes subject to a self-exclusion deed a er joining the Club’s Loyalty Program, the individual must advise The Club immediately.

I wish to receive marke ng material about The Club’s special off ers, vouchers, benefi ts, promo ons, discounts and services including, but not limited to entertainment, food, beverage and off ers that include alcohol related ac vi es. Yes please mark preferred methods below NoMethods of Contact:Mail Yes NoSMS Yes No

Email Yes No

I wish to receive informa on about gaming machines/promo ons Yes No

Keep me up to date about what’s happening at the Club Both Club Kilsyth Club Ringwood

Areas of Interest please mark all relevant fi elds

Live Bands

Bingo

Poker

Trivia

STAFF USE ONLYDate Received / /

Received by Entered by

Iden fi ca on Type & Number

Member Number Expiry / /

Sports

Bistro & Food Specials

Morning Melodies

Beverage (inc. alcoholic beverages)

AFL Team