2018 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.
Given Name *
Your answer
Surname *
Your answer
Address *
If applicant is under 18 years of age, please list the applicant's parents or guardians address.
Your answer
Phone number *
If applicant is under 18 years of age, please list the applicant's parents or guardians contact number.
Your answer
Email address *
If applicant is under 18 years of age, please list the applicant's parents or guardians email address.
Your answer
Date of Birth *
MM
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DD
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YYYY
Primary Club *
You MUST be a current, financial member of a Skate Victoria affiliated Club
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