BACK TO BASICS WERE COMING HOME 2013 MORELAND

“BACK TO BASICS – WERE COMING HOME” 2013 MORELAND ZEBRAS MEMBERSHIP APPLICATION AND RENEWAL FORM ABN: 31 -206 -809 -466 We need your financial and vocal support in 2013!!! 2013 JUVE 500 Club Privileges - Entry to all home games and VIP privileges - Invitation for member and guest to Club’s Presentation Night - Free car parking. - Voting Rights at Annual General Meeting 2013 JUVENTUS Club Support, Full, Pensioner and Life Membership Privileges. - Entry to all home games - Free car parking. - Voting Rights at the Annual General Meeting N. B: (i) (ii) Life members will be entitled to voting rights on payment of a $100 fee. All junior registrations receive automatic membership – 1 membership (vote) per family. JUVE 500 Club Juventus Support Club Full Membership Pensioner Membership Life Members Fee Existing Member Mr/Mrs/Ms/Miss Qty____ Qty____ @ $500 each (inc GST) @ $250 each (inc GST) @ $100 each (inc GST) @ $80 each (inc GST) @ $100 each (inc GST) New Member Surname: Juniors Member Total $__________ Total $_____ (Please tick box) …………………. . Given name: ……. ……………………………. . Address: …………………………………………. . . Suburb: ……………Post Code: …………Occupation………. . . …. Tel: Bus: …………. . A/h: ……………. . . ………. Mobile: ……………. E-mail address…………………………………………. . . Signature: ……………Dated: ………………. Paid: Cash / Cheque Payable to: Brunswick Juventus Football Club Inc. P. O. Box 783 LPO 132 Elizabeth Street, Coburg. VIC. 3058. Banking Details: ANZ Bank BSB: 013 -270 Account No: 4793 -02843 Proposed by: …………………Seconded by…………. . Accepted …………. . Card/Membership no: ……………. . All prices quoted include GST.