Australian Hellenic Game &
Conservation Association
Registered No. A0034985C
NEW MEMBER / MEMBERSHIP RENEWAL
2017
MEMBERSHIP NUMBER: ……………………………………………………………………………………………………………………………………………………
SURNAME: …………………..…………………………………………….… FIRST NAME: ………………………….…………………………………….…………..
ADDRESS: …..………………………………………………………….……………………………………….…………………………………………………..…………....
SHOOTERS LICENCE NO: ……………………………………...……….EXP. DATE: …………………..…/………...............……../….………..………..…
TELEPHONE NUMBER: ………………………………..……………… .MOBILE: ………………………………………….………….………………….………….
E-MAIL …………………………………….……………………………………………………………………………………………DOB: …………/…………./…………
TYPE OF MEMBERSHIP
GENERAL MEMBER
$115
JUNIOR
$40
FAMILY (2 adults and kids – U/18)
$135
CONCESSION
$70
EXPIRED MEMBERSHIP FEE
$50
TOTAL
NOTE:
All memberships expire 31/12/2017
MEMBERSHIPS EXPIRED LONGER THAN 1 YEAR.
$
FAMILY MEMBERSHIPS
Name ………………………………….…………….….…..... Age ……….…
Name ………...……………..………………….……….….... Age ……….…
Name ………………………………….…………….….…..... Age ……….…
Name ………...……………..………………….……….….... Age ……….…
Name ………………………………….…………….….…..... Age ……….…
Name ………...……………..………………….……….….... Age ……….…
CONCESSION MEMBERSHIP
Pension Card Number: ………………………………………………………………………………………………………………………………………………………
The above information is correct and I hereby apply for membership of A.H.G.C and agree to
abide by its code of conduct.
Signature…………………………………………………..Date…………………….……………
Please make all cheques and money orders payable to :
Australian Hellenic Game and Conservation Inc.
P.O. Box 2047
Lalor 3075
Application received on …..…/……..../…….. Receipt Number ………………….…………………Total Paid……...…………………………