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Gold Membership Form

Email(*)
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First Name(*)
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Last Name(*)
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Street Address(*)
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Suburb(*)
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State(*)
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Postcode(*)
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Country(*)
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Mobile No(*)
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D.O.B(*)
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Membership Type(*)
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Business Name(*)
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Manly Mates Rates discount(*)
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Website(*)
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Address(*)
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Email(*)
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Phone No(*)
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Polo Shirt Size(*)
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Polo Shirt Type(*)
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Payment Type(*)
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You will be contact by the club shortly after submitting this application to take your credit card details over the phone.

Please make all cheques payable to MWDCC and mark clearly with your full name on the reverse. Please mail all cheques to PO Box 1239, Manly NSW 1655.

Please deposit your subscription fee into the below bank account. For the description, please use your first name initial, surname & "Manly BB" (i.e. "D Gainsford Manly BB"). Bank details are: Bank of Queensland (Manly) - Account Name: MWDCC - BSB: 122 712 - Account Number: 2074 3076

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Applications will only be processed once payment is received within five (5) working days. Please note that Blue Blood Membership is free for all MWDCC Life Members, although payment will be accepted. You will be sent a copy of this e-form when you hit 'Submit'. If this does not arrive, please contact us directly.

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