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Junior Membership
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Name
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Email
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Mobile
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Postal Address
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Street Address
Address Line 2
City
State
Post Code
Date of Birth
Day
Month
Year
Consent
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I confirm I am 18 years of age or over.
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Consent
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I hereby apply to become a member of the Association and agree to be bound by the rules of the Association as per the Mildura Harness Racing Club Rule Book supplied on application.
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Yes I would like to be subscribed to the newsletter
1x Adult Membership
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How Many Juniors?
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1
2
3
4
5
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7
8
9
10
Junior Details #1
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Full Name
Date of Birth
Junior Details #2
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Full Name
Date of Birth
Junior Details #3
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Full Name
Date of Birth
Junior Details #4
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Full Name
Date of Birth
Junior Details #5
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Full Name
Date of Birth
Junior Details #6
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Full Name
Date of Birth
Junior Details #7
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Full Name
Date of Birth
Junior Details #8
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Full Name
Date of Birth
Junior Details #9
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Full Name
Date of Birth
Junior Details #10
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Full Name
Date of Birth
Parent/Guardian Email Address
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Parent/Guardian Mobile
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Postal Address
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Street Address
Address Line 2
City
State
Post Code
Consent
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I hereby apply to become a member of the Association for the 2017-2018 financial year, and agree to be bound by the rules of the Association. I understand that as a Junior Member I have no voting powers.
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Consent
Yes I would like to be subscribed to the newsletter
Total Membership Cost
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Price:
$ 1.00
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