United Field and Retrieving Q73 * Equipment and Amenities Fee *

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Please fill out this form and organise payment of fee by one of the options listed below.

Please Note: Questions with a * require an entry.

Surname *

Given Names *

SSAA Membership Number and Expiry Date *

Address *

Email Address *

Phone Numbers *

I apply for membership of the designated Club and if accepted by a general meeting of members, I will abide by the Code of Conduct and the Constitution of this chosen WGAA Club/Branch. NOTE -To be a member of this Branch you must have current membership of the SSAA. NOTE - Photos may be taken at our events and used on our website. If you do not wish for any images to be published please notify the Club/Branch Executive in writing. *

I agree to the above stated conditions

I wish to discuss the above stated conditions (we will contact you to clarify any concerns)

Payment Method *

I will deposit the fee ($15 Single, $20 Family) into BSB: 124068 ACC: 20508140 (Refer Name)

I will pay at the next Club Meeting

I will pay at the next Trial

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