PRESTON LIONS FOOTBALL CLUB
Membership Application Form - 2014
1. APPLICANT DETAILS
Full Name:
Gender:
‰ Male ‰ Female
Address:
Suburb:
State:
Phone:
Postcode:
Mobile:
Email:
Date of Birth:
Pensioner / Concession Card Number: (if applicable)
Were you a PLFC Member in 2013? (please tick)
‰ Yes
‰ No
2. MEMBERSHIP CATEGORY
CATEGORY
ADULT (please tick)
PENSIONER / CONCESSION (please tick)
Gold Membership
‰ $150
‰ $120
Silver Membership
‰ $100
‰ $70
Season Pass Membership
‰ $70
‰ $40
3. DEBT DEMOLITION DONATION
If you would also like to make a financial contribution to the club’s Debt
Demolition Fund, please indicate the donation amount in this section.
‰ $5
‰ $75
‰ $10
‰ $20
‰ $100
‰ $200
‰ $500
‰ $750
‰ $50
‰ $250
‰ $1,000
‰ Other Amount $ ______________
4. PAYMENT DETAILS
‰ Cash
Total
Cost:
$
Payment
Type:
(please tick)
‰ Cheque*
‰ Electronic Funds Transfer (EFT)**
* Please make cheques payable to Preston Lions
** If paying by Electronic Funds Transfer (EFT) please credit the following bank account:
BSB: 063-123 Account # 10443969
5. APPLICANT DECLARATION
I agree to be bound and will abide by the club’s Rules, Constitution and all of the relevant Club Codes of Conduct/Behaviour and
Conditions of Entry (available from www.plfc.com.au) at all venues and for for matches involving the Preston Lions Football Club.
Signature:
Date:
Please hand your completed application form with payment details to an
authorised club representative or mail your completed form with payment
details to: Preston Lions Football Club, PO Box 382, PRESTON, VIC 3072
‰
OFFICE USE ONLY
Date:
Card #:
Receipt #:
Your privacy is important to us. The information you provide will be kept strictly confidential and will not be forwarded to any third parties. If you do
not consent to receiving any promotional material from PLFC and its partners or sponsors, please tick the box.
Preston Makedonia Soccer Club Limited A.B.N. 88 005 444 575