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BSAWA MEMBERSHIP
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| NAME:........................................................................................................ | ||
| ADDRESS:................................................................................P/CODE:........... | ||
| OCCUPATION:................................................................................ | ||
| PHONE: HOME:...........................................BUSINESS:.................................... | ||
| FAX................................................MOBILE......................................... | ||
| E MAIL ADDRESS | ||
| I PLAY AT / AM A MEMBER OF THE .............................................CLUB/CENTRE | ||
| I wish to: renew my membership / become a member. | ||
| FULL REGISTERED (with voting rights) | $50 | |
| REFEREE (Level 3 or better).with voting rights | $35 | |
| ASSOCIATE | $35 | |
| JUNIOR Under 16 Date of Birth | $10 | |
| JUNIOR 16-20 Date of Birth | $20 | |
| SENIORS over 65 | $20 | |
| SENIORS over 65 & ABSR financial Referee | $10 | |
| Referee (inc ABSR Membership) | $40 | |
| ABSR financial Referee | $20 | |
| DISABILITY PENSION HOLDER | $20 | |
| I agree to abide by the constitution and by-laws of the Association. | ||
| Signature....................................... Date.........../......../2006 | ||
| Cheque enclosed for $................ | ||
| Please send cheques to: | ||
| BSAWA | ||
| PO Box 1695 | ||
| East Victoria Park WA 6981 | ||
| Telephone/Fax No: 9361 9019 | ||
PO Box 223 North Perth WA 6906
Ph/Fax: 08 9238 6918
