Benalla Bushwalking Club Membership Application
  The annual membership fee is $45 per person ($40 (incl. $5 discount) if paid prior to March 31). Full time students, if accompanied on walks by their paid up parent(s), are covered by the parent(s) membership.

  Unfortunately, banks are no longer accepting cheques and we are not able to accept eftpos payments within this form. Please complete and submit this form and tender payment of subscription by online payment (see details below under "Payment Method")
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No. of Applicants *
Payment Amount *
Payment Method *
  For online payments BSB  803078 Acc. No. 137269.  Please use name as reference. 
New or Existing Member? *
Applicant Name *
Postal Address
Town
Postcode
Email Address
Phone
Email address for newsletter
Age Range of applicant *
Required
Agreement *
Required
Emergency Contact
  In the unlikely event of accident or injury the following information is needed and may be used for emergency management purposes.
Contact Name *
Home Address *
Home Telephone
Mobile Telephone
Relationship to Applicant *
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