MEMBERSHIP APPLICATION FORM

New members should be aware that renewal payments are applicable each year and must be paid by the member to remain financial.

MEMBERSHIP TYPE/PRICE

PERSONAL DETAILS

HOME ADDRESS

PREFERRED MAILING ADDRESS If different to home address

Contact Details

(*Mandatory Fields)

DECLARATIONS

I am over the age of 18 years and wish to become a Member of Club Marconi and request that you enter my name on the Registrar of Members accordingly. I agree to be bound by your Constitution and any rules, regulations or by-laws of the Club. I declare that my membership hasn’t been revoked by the Board of Club Marconi. I understand that membership is not transferable and fees are not refundable. Perpetual membership exists for the life of the member or until a written resignation letter is received.

PROMOTIONAL CONSENT

You may withdraw your consent at any time by contacting Club Marconi on (02) 9822 3333. Player Activity Statements are available on request in accordance with Clause 42 of the Gaming Machines Regulations 2002.

PRIVACY ACT

Under privacy legislation, members that do not wish to receive information from the club may do so except in the event that this contravenes the law. Your personal information will be securely stored on the Club Marconi Membership database and will not be disclosed to any third parties without your consent.

THINK! ABOUT YOUR CHOICES. CALL GAMBLING HELP 1800 858 858 www.gamblinghelp.nsw.gov.au