2018 Skate Victoria Roller Hockey 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.
Please put street address on one line; and the suburb, state and postal code on a separate line.
Please enter your home phone; mobile; and/or work phone.
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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