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Member Registration
Member Registration
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Primary Member First Name*
Primary Member Last Name*
Date of Birth*
Email address*
Spouse Full Name
Date of Birth
Email address
Anniversary Date
Do you have parents staying with you?
Parent 1 Full Name
Date of Birth
Parent 2 Full Name
Date of Birth
Is anyone in your family allergic to any food items?
Allergy Details*
Do you own a business?
Business Name*
Occupation*
Employer
Residential Address - Street Name & Number*
Suburb*
State*
Please Select State*
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode*
Is mailing address different ?
Full Mailing Address*
Phone*
Spouse Phone
Do you have kids?
No
Yes
Numer of Kids*
Add Details
Interest/Hobbies*
How did you first find out about Western Gymkhana Club*
Facebook
Friends
Website
News
Other
Does your family agree to do volunteer service during club opens and other events as and when called upon by the club?*
Yes
No
Can your contact details be shared with other club members in the club's contact directory?*
Yes
No
Primary Member - Current Certifications - for volunteering at club
Responsible Serving of Alcohol (RSA)
First Aid Course
Food Handling
Fire Warden
Working with Children Check
Spouse - Current Certifications - for volunteering at club
Responsible Serving of Alcohol (RSA)
First Aid Course
Food Handling
Fire Warden
Working with Children Check
Name of nearest contact in case of emergency*
Phone number of nearest contact in case of emergency*
Your Reference Contact - Name*
Your Reference Contact - Phone*
Why do you want to join WGC?(Please answer in few words)*
I have read the club's values and expected behaviour statements and will abide by those. I also agree to follow and abide the Model rules adopted by Western Gymkhana Club as per Associations Incorporation Reform Act 2012 *
Yes
No
I agree for my family photos to at club’s events to be used in WGC’s website; Facebook page; marketing materials or media coverage *
Yes
No
