Club Membership Form

Club Details

Club :  New Member  Returning Member

Membership Type (please circle): SEMESTER ANNUAL Membership Cost:

Membership Category (please circle): RMIT COMMUNITY OTHER

. RMIT Students, RMIT Graduates, RMIT staff General member of public, Other Uni students

How did you find out about the club?

 Orientation □ Email □ Web page □ Poster/notice □ Friend/Family □ Other

Personal Details
First Name: Surname:

Address: Gender: Male / Female

Town/City: Post Code:

Home Phone: Work Phone:

Mobile Phone: Date of Birth:

E-mail:

RMIT Student Number:

Course of Study:

Campus: Current Year: Expected Completion:

 TAFE Student  Post Grad Student  Part time Student  Full Time Student
 Higher Ed Student  Mature Age Student  International Student  First Year Student

Emergency Contact Details

First Name: Surname:

Mobile Phone: Relationship to you:

Home Phone: Work Phone:

Conditions of Undertaking Club Activities

Student Responsibility In becoming a Member of the abovementioned Club, I agree to abide by all Club Rules and Regulations and the RMIT Link Sport
& Recreation Clubs’ Charter as it pertains to my membership. I understand that my membership fee is non-refundable and shall expire prior to the official
starting date of the following RMIT academic year, and that I must notify the Club in writing should I wish to withdraw as a Club Member.
Use of Information I understand that my membership details may be used by the Club and/or RMIT Union Sport & Recreation for the purposes of
promotion and advertising.

Participant’s Signature: Date:

Date of Issue: 16/02/11