2019 Skate Victoria Roller Derby Membership Form
I hereby apply for membership of Skate Victoria Inc. In so applying and in consideration of my application being accepted I have read, acknowledged and agreed to the declaration including in the warning, exclusion of liability release and indemnity clauses on this form.
I acknowledge that Skate Victoria may reject this application at its discretion.
I acknowledge that if my application for membership is successful I will be entitled to all benefits, advantages and services of membership.
If applicant is under 18 years of age, please list the applicant's parents or guardians address.
If applicant is under 18 years of age, please list the applicant's parents or guardians contact number.
If applicant is under 18 years of age, please list the applicant's parents or guardians email address.
Date of Birth
You MUST be a current, financial member of a Skate Victoria affiliated Club
New South Wales
Australian Capital Territory
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