Bilgola S.L.S.C. Membership

Gym Access Application 2004/2005

 

Application Date:

 

Amount Paid:

 

 

Induction Date:

 

Registrar Initial:

 

 

Receipt No.

 

Key No.

 

Membership Details:

Surname:

 

First Name: & Initial:

 

Date of Birth:

 

Mailing Address:

(Don’t forget the Post Code)

 

Occupation:

 

    ⃞ Male     ⃞ Female

Home Phone:

 

Email:

 

Work Phone:

 

 

   

Mobile Phone:

 

Fax:

 

 

 

SLSC Membership Type:

 ⃞ Social

 ⃞ Probationary

 ⃞ Active Senior (18+)

 ⃞ Associate (Spouse of Member)

 ⃞ Active Cadet (13-15yrs)

 ⃞ Active Reserve

 ⃞ Honorary

 ⃞ Active Junior (15-18yrs)

 ⃞ Long Standing  

 ⃞ Berger

⃞ Distinguished Service

 ⃞ Life Member

               

GYM FEES

(for season 03/04)

Gym Contribution                $20                         o

Key Deposit                          $30                         o

                               

CONDITIONS

As a condition of my membership I understand that:

  1. I must be a member of Bilgola SLSC to be able to utilize the gym facility.
  1. I must under no circumstances allow access to anyone who is not a member of Bilgola SLSC.
  1. I must lock all access doors after using the gym.
  1. I must sign the gym log sheet upon each visit.
  1. I must not take any equipment off the premises.
  1. I may only use the gym facility between the hours of 6am and 9pm.
  1. If I am under 18 years of age I must accompanied by an adult.
  1. My privileges may be revoked if I fail to adhere to the set conditions.

 

NAME: ___________________________________Signed:   _________________________________Date:_____________