Coolum Surf Life Saving Club

Declaration
"To the Management Committee, I hereby make application for membership to Coolum Beach Surf Life Saving Supporters Association Inc. I declare that I am over the age of 18 years, and if accepted, agree to abide by the Club rules as well as the Liquor and Gaming Laws."

The Coolum Beach Surf Life Saving Supporters Association Inc. is bound by the Queensland Club Industry Privacy Code and is committed to the privacy of your personal information supplied on this form. The Club will use the information to provide its facilities and services to you and also plan new services and improve existing ones. This will include sending to you Club promotional materials and offers. If you do not wish to receive any promotional materials or offers, the Club will, upon your written request, ensure you do not receive them. Your personal information will be publicly displayed at the Club prior to any acceptance of you as a member. Please contact one of our staff if you have any questions regarding the Privacy Code.

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Please complete the following form and send it to us via the submission button provided,

thank you.

Membership Type

Social 1 year $10 (incl GST)     Silver 10 years $100 (incl GST)
Gold (life) $250 (incl GST)
Tick One Mr     Mrs     Ms     Miss

Surname:
First Names:
Address:
Post Code:
Home Phone:
Work Phone No:
E-mail Address:
Do you have a partner yes/no:
Date of Birth:
Occupation:

Please use the following form for general enquiries and/or special requests
THANK YOU