I enclose
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Joining Fee $ 20 |
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3 Years subscription $ 60 |
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Total enclosed $ |
Cheque / Money Order
Yarra Ranges Logo↘
- If applicable
- Mandatory
to
Ulysses Club Inc
Please do not post cash
By signing below I acknowledge and understand that this application does not guarantee my acceptance as a member of the club. If accepted, I agree to abide by the constitution of the club and uphold it's principles.
**I also grant permission for my name, postal address
and phone number to be published in a membership directory
produced by the club for sale only to other
members.
** Strike out this sentence if you do not wish to be
listed in the membership directory.
Signed
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Date …...... / ......... / 20..…
PAYMENT BY CREDIT CARD
PLEASE DEBIT MY: BANKCARD
/ MASTERCARD /
VISA
Please ensure you have entered all the numbers on your
credit card in the boxes below,
plus your full name as it
appears on your card, signature & expiry date in the spaces below.
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Cardholders Name....................…….................... Signature...........………….............................
Expiry Date on card …… / …….