New Membership

Membership runs from 1st July until 30th June the year after.

First Name*

Last Name*

Spouse / other

Contact No.

Street Address

Suburb

City

Post code

Landline No.*

Cell Phone No.*

Date of Birth*

Driver Licence No.

Expiry Date:

First Aid Cert

Expiry Date:

Occupation

E-Mail Address*

Type of Membership please (Click one)*


Ordinary Member $30	Family Member $40 (2 Adults & 2 Children)	Junior Member $15 (under 18)

Comments

Payment Details

Payment was made by:*
Cash Bank deposit Cheque
Bank Deposit details

Account Name: FDSR

Account Number: 03-0626-0659376-000

Please use your First name & surname as a reference and return this completed form if you printed this form.

*Are required feilds, please make sure you have filled these in.