Blue Blood Membership – Apply Online

First Name*

Last Name*

Email Address*

Street Address*

Suburb*

State*
NSWQLDVICACTTASSAWANT

Country*

Mobile Number*

Date of Birth*

Membership Type*
Please Select$180 - Eddie Robinson Package$110 - Jim Burke Package$65 - Keith Miller Package

[group EddieRobinsonPackage]

Business Name

Manly Mates Rates

Website

Business Address

Business Email

Business Phone Number

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Merchandise*
Please SelectCapPolo Shirt

[group polo-shirt]

Shirt Size
Please SelectSmallMediumLargeX Large2 XL

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Payment Type*
Please SelectBy ChequeBy Direct DepositBy Credit CardLife MemberOther

[group Cheque]
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.
[/group]

[group DirectDeposit]
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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[group CreditCard]
You will be contact by the club shortly after submitting this application to take your credit card details over the
phone.
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Comments

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.