2013 membership - we are south melbourne
DESCRIPTION
Buy your 2013 Membership today at wearesouthmelbourne.com.auTRANSCRIPT
2013 SOUTH MELBOURNE FC MEMBERSHIP APPLICATION FORM
GIVEN NAME SECOND ADULT
DATE OF BIRTH
FIRST CHILD
DATE OF BIRTH / UNDER 16
SECOND CHILD
DATE OF BIRTH / UNDER 16
SURNAME
ADDRESS
SUBURB
STATE
PHONE (HOME)
EMAIL ADDRESS CASH
Credit Card No.
Expiry Date.
Print Name:
Signature:
Total Payable:
Send Form to: SMFC Membership Department P.O. Box 1349 South Melbourne VIC 3205 Phone: 9645 9797 Fax: 9645 9796
CHEQUE
MASTERCARD
VISA
MONEY ORDER
SOUTH WHITE ADULT SEASON PASS - ($110)
SOUTH WHITE JUNIOR SEASON PASS - (FREE)
SOUTH WHITE CONCESSION SEASON PASS - ($90)
SOUTH BLUE MEMBERSHIP FAMILY PASS - ($199)
SOUTH GOLD MEMBERSHIP - ($175)
HELLAS 100 MEMBERSHIP - ($399)
If you do not consent to receiving promotional material from SMFC and its sponsors please tick this box (Note: Your details will not be provided to any third party).
Were you a member in 2012? (Please tick)
I am a new member and was nominated by:
YES NO
POST CODE DATE OF BIRTH
PHONE (MOBILE)
Personal Details Family Membership Details
Payment Details
Select 2013 South Melbourne FC Membership
/
Purchase online at wearesouthmelbourne.com.au
2013 SOUTH MELBOURNE FC MEMBERSHIP APPLICATION FORM
GIVEN NAME SECOND ADULT
DATE OF BIRTH
FIRST CHILD
DATE OF BIRTH / UNDER 16
SECOND CHILD
DATE OF BIRTH / UNDER 16
SURNAME
ADDRESS
SUBURB
STATE
PHONE (HOME)
EMAIL ADDRESS CASH
Credit Card No.
Expiry Date.
Print Name:
Signature:
Total Payable:
Send Form to: SMFC Membership Department P.O. Box 1349 South Melbourne VIC 3205 Phone: 9645 9797 Fax: 9645 9796
CHEQUE
MASTERCARD
VISA
MONEY ORDER
SOUTH WHITE ADULT SEASON PASS - ($110)
SOUTH WHITE JUNIOR SEASON PASS - (FREE)
SOUTH WHITE CONCESSION SEASON PASS - ($90)
SOUTH BLUE MEMBERSHIP FAMILY PASS - ($199)
SOUTH GOLD MEMBERSHIP - ($175)
HELLAS 100 MEMBERSHIP - ($399)
If you do not consent to receiving promotional material from SMFC and its sponsors please tick this box (Note: Your details will not be provided to any third party).
Were you a member in 2012? (Please tick)
I am a new member and was nominated by:
YES NO
POST CODE DATE OF BIRTH
PHONE (MOBILE)
Personal Details Family Membership Details
Payment Details
Select 2013 South Melbourne FC Membership
/
Purchase online at wearesouthmelbourne.com.au
