New Membership

Membership runs from 1st July until 30th June the year after.
First Name*
Last Name*
Emergency Contact 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)*

Full $30.00

Junior $15.00
(under 18)

Family $40.00
(2 Adults & 2 Children)
Comments
Profile image*


Payment Details
Payment was made by:*

Cash Bank deposit

Bank Deposit details
Account Name:FDSRS
Account Number:FDSR Bank Acct No = 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 fields, please make sure you have filled these in.