Members Application Form
Port Macquarie Pacers Running Club Incorporated Individual Members Application Form
Email address *
Memberships expire 31 August 2019. New members $75 (includes a singlet in your choice of size). Returning members $40, Children $15. All memberships are subject to committee approval, as outlined in the club constitution.
Name *
Your answer
Address *
Your answer
Gmail address (Our calendar and members area require a gmail address. Please supply a gmail address if you wish to get access to both the calendar and members website)
Your answer
Phone number *
Your answer
Date Of Birth *
MM
/
DD
/
YYYY
Emergency Contact Name *
Your answer
Emergency Contact Address *
Your answer
Emergency Contact Phone *
Your answer
Payment Method (in order of our preference) *
Womens Singlet (new adult members only)
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Your answer
Mens Singlet (new adult members only)
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Your answer
Electronic Signature *
Required
A copy of your responses will be emailed to the address you provided.
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