2018 Skate Victoria Roller Derby Club Affiliation
Skate Victoria Roller Derby Club Membership provides coverage for Public Liability, Professional Indemnity and Individual Memberships. Insurance coverage will become void if a club does not adhere to the Skate Victoria Roller Derby Membership Bylaw available from http://www.skatevictoria.com.au/documents-and-policies/

2018 Roller Derby Membership Fees are inclusive of $20M Public Liability Insurance cover, however cover will not be endorsed or Certificate of Currency issued until this form together with the required fee is received by the Skate Victoria Office.

All memberships expire on 1st February 2019 and are subject to ratification by the Skate Victoria Executive.

Privacy Statement: Information contained on this form will be treated as confidential and SV Inc will not provide details contained in this application to any other organization except for the purpose of issuing Certificate of Currencies and /or competition information.

Skate Victoria Roller Derby Club 2018 Registration Fee $150.00 Payment made to Skate Victoria BSB: 063 125 Account 1002 9746 Ref: CLUB NAME

Registered Name of Club *
Date last Incorporation Annual Statement lodged *
Incorporation Number *
Official Club Address *
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