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Select Club Membership Your Contact About You

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Location Level Details  

SUMMARY AND CONFIRMATION

Membership Start Date

28/11/2022 

Please Confirm all details Below are correct.

Name

CARLOS ANDRES ARISTIZABAL MORENO

Mobile Phone
Home Phone
Work Phone

0432386947

Email Address

ING.CARLOS.ARISTIZABAL.MORENO@GMAIL.COM

Address

29 AUDLEY STREET, COBURG VIC 3058

Hi. How can we help?
Emergency Contact
Emergency Phone

LYDA JOHANNA SANCHEZ 0481773125

(GIRLFRIEND)

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Membership Type
Home Location
Single Club Membership Coburg

Membership Pro Rata

Your membership fee from 28/11/2022 to 07/12/2022 is $22.71 ($31.80 / 14 =

$2.27 Per Day X 10 Days)

Your first Direct Debit will be processed Thursday 08/12/2022 and every fortnight
thereafter. If applicable, membership credit will be used at time of next Direct
Debit.

Membership Amount
Access Pass

$31.80 (Fortnightly Membership) $0.00

Joining Fee Add-ons

$0.00 $0.00

Todays Payment

$22.71

Staff Code (Optional)

CARLOS

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