2015-16 Membership Form
Please complete form. Payment is to be made to Enfield Lifesaving Club via direct deposit by 10th October. Please use surname as reference.
EFT to Enfield Lifesaving Club
BSB 062196
Account 10718577
Competitor Non Competitor
1st Member $130 $55
2nd Member $100
3rd + $ 90
U/8 $ 90
Surname *
Your answer
First Name *
Your answer
Address *
Your answer
email address *
Parent email if under 18
Your answer
Your answer
Mobile phone number *
Parent number if under 18
Your answer
Age as of January 1st 2016 *
Your answer
Type of Membership *
We encourage all under 18 members to be competitors. You are able to change membership from non-competitor to competitor.
I give permission for photographs to be used in print, or digital media, including on the website for a period of 5 years after membership. *
Emergency Contact *
Please supply name, contact number and relationship.
Your answer
Medicare no. *
Your answer
Do you have any allergies? *
Please provide details of allergies
Your answer
Please list any medical conditions, medication or injuries. *
Your answer
As a member (parent/guardian), I agree to abide by the ELSC Constitution. I am aware of the risks involved in the sport of lifesaving.All information is accurate to the best of my knowledge. *
You will be required to sign a declaration.
Working with children number if applicable
Your answer
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