Membership Form

Membership Form
Belgian Club Victoria Inc
ABN 83 248 832 112

Becoming a member is not all about supporting the continuity of the

Belgian club of Victoria.

Being a member reveals a bundle of benefits and advantages, such as:
- enjoying the Belgian culture&cuisine and share your experiences with fellow Belgians in Victoria,
- meeting and greeting Belgian artists and sport teams touring across Australia,
- and above all, getting free tickets, membership discounts or free upgrades with our new and expanding Australian/Belgian company partner program.

To immediately benefit from the above, complete the membership form below and join up today.

We highly appreciate your contribution.

the committee board

Membership Form 2011-2012

Name (will appear on your Membership Card) *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Mobile (or most convenient phone number) *

Family (please tick if applicable)

Full Name Partner *

First

Last

Email Partner *

Children (please tick if applicable) *

# Children younger than 13 *

Comments/Suggestions *

Office Use Only *

Membership Card Number *

In the event of my admission as a member, I agree to be bound by the rules and regulations of the Association for the time being in force and to pay all fees (joining fee + annual subscription) within the required period.

I/We understand that this application is confidential and the information contained is to be used only for application to the Belgian Club of Victoria Inc. I/We exclude the Belgian Club of Victoria Inc, its members and office holders of any liability both direct and indirect which may arise from my/our application for membership, as outlined above, or from club related matters which may arise during or as a consequence of my/our membership term.

Thanks a lot for your subscription.

Please complete the form online and submit it.

Alternatively, you can print the form, complete all the details and send it in the mail, with a cheque, to:

The Belgian Club of Victoria
Att. Membership Secretary
PO Box 342
Elsternwick 3185

The joining and subsequent fees can be deposited in the Belgian Club account at the Bendigo Bank:

BSB: 633 108
Account number: 1376 85616

Could you please clearly state your family name when you transfer the amount.

Membership Fees