CAMPSIE SOUTH BOWLING & RECREATION CLUB LTD
Cnr Alfred & Jarrett Streets, Clemton Park NSW 2206
Telephone: (02) 9787-1099 Facsimile: (02) 9787-2391
ABN 58 001 050 040
APPLICATION FOR MEMBERSHIP - 2019 to
Includes RNSWBA Affiliation Fees


PLEASE USE BLOCK LETTERS
Surname:
Christian/Given Names:
Date of Brith

Residential Address:
Post Code:
Home phone:
Mobile:

E-mail:
Drivers Licence no:

List membership of other Clubs:
Have you ever been refused entry or dealt with on any matter by any Licensee of a Club or Hotel, or any Committee of such? If so, write particulars below:
Privacy Acknowledgement: The Club’s privacy policy has been explained to me and I receive information about Club functions, events and or promotions.

Proof of Age sighted and attached: