GOLD COAST Seniors OntheNet Inc.

Application for New Membership –                                            

Single or Double

DETAILS - PLEASE PRINT CLEARLY

Surname/s: ……………………………………………. Given Name/s ……………………………….

Address line 1: ……………………………………………………………………………………………

Address line 2: ……………………………………………………………Post Code: …………………

Phone: …………………………….... E-mail address: …………………………………………………

FEES

Annual Subscriptions are from July 1 to June 30. There is a part-year discount if joining after October 31. There is a one-time joining fee of $5 included in the first year subscription.

• Join between July 1 and October 31 ………………………… Single $35, Double $45
• Join between  November 1 and March 31 …….…………….. Single $30, Double $40
• Join after April 1 and the membership extends to June 30

                      of the following financial year (up to 15 months) …….. Single $40, Double $50

DECLARATIONS

I/We enclose/ attach the amount of $ ………. as our subscription for Single/ Double membership.

I/we are of 50 years old or older and agree to our personal details, as declared above, being entered into the Register of Members of Gold Coast Seniors OntheNet.

Note that members with computer-related commercial interests are not allowed to advertise within Seniors OntheNet, the Web pages or newsletters, or hold any club office or position that may give them an actual or perceived commercial advantage with other club members.

Signed: …………………………………….           …………………………………………………………

Proposed by: …………………………………. Seconded by: ……………………………………………

(who must be financial members of Club. Membership is subject to Committee approval.)

CONTACT US

Address:          Suite 3/ 47 Nerang St. Southport 4215                           Telephone 07 5591 5766

Office Hours:   Monday to Thursday, 9am to 4pm

Email address: sotnadmin@futureweb.com.au

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FOR OFFICE USE

Amount paid: $ …………….                            Receipt No. ……………………. Date: ………………

Member is financial until date:  June 30, 20 ………….