REPLACEMENT
MEMBERSHIP CARDS
DECLARATION BY (Member card holder please print clearly below)
The fee for replacement membership card/s is $30 (non-refundable).
Surname
First Names
Title
Member Number
Address
Postcode
Date of Birth
(Mob)
Phone (W)
(H)Email
PLEASE READ CAREFULLY AND SIGN BELOW
I declare that I am a Member of the Sydney Cricket Ground/Allianz Stadium; and
1. to the best of my knowledge the card/s were (please tick);
� damaged (please complete credit card details below)
� lost (please complete credit card details below)
� stolen (please complete point 2)
2. the theft was reported to
Police Station, Police report number:
Note: The card/s will be issued free of charge if a police report number is provided.
3. I understand that my membership card/s will be cancelled upon submission of this form and that new card/s
will be issued within 10 working days.
SignatureDate
CREDIT CARD DETAILS
Card Type:
Card Number:
Expiry Date:
CVC Number (3-digit security code):
SignatureDate:
MEMBERSHIP SERVICES CONTACT DETAILS
GPO Box 150, Sydney NSW 2001
Telephone
1800 80 11 55
Fax
02 9380 0398
Email
[email protected]
Website
sydneycricketground.com.au
····· OFFICE USE ONLY ·····
Member Number:
Date Received:
Processed by: