BACK TO BASICS WERE COMING HOME2013 MORELAND ZEBRAS MEMBERSHIP APPLICATION AND RENEWAL FORMABN: 31-206-809-466

JUVE 500 Club Qty____ @ $500 each (inc GST)Total $__________Juventus Support Club Qty____ @ $250 each (inc GST)Total $__________Full Membership Qty____ @ $100 each (inc GST)Total $__________Pensioner Membership Qty____ @ $80 each (inc GST)Total $__________Life Members Fee Qty____ @ $100 each (inc GST)Total $__________

Existing Member New Member Juniors Member (Please tick box)

Mr/Mrs/Ms/Miss Surname: ..... Given name:....

Address:..... .

Suburb: Post Code: Occupation......

Tel: Bus: ....A/h: ....Mobile: .

E-mail address...

Signature: Dated: .

Paid: Cash / Cheque Payable to:Brunswick Juventus Football Club Inc. P.O. Box 783 LPO 132 Elizabeth Street, Coburg. VIC. 3058.

Banking Details: ANZ Bank BSB: 013-270 Account No: 4793-02843Proposed by: Seconded by.... Accepted ..Card/Membership no:.. All prices quoted include GST.We need your financial and vocal support in 2013!!!2013 JUVE 500 Club Privileges- Entry to all home games and VIP privileges- Invitation for member and guest to Clubs Presentation Night - Free car parking. - Voting Rights at Annual General Meeting2013 JUVENTUS Club Support, Full, Pensioner and Life Membership Privileges.- Entry to all home games - Free car parking. - Voting Rights at the Annual General Meeting

N.B:Life members will be entitled to voting rights on payment of a $100 fee.All junior registrations receive automatic membership 1 membership (vote) per family.