Subscribe for P - Melbourne Women's Walking Club

PROSPECTIVE MEMBER REGISTRATION FORM

Please complete the form below. If you are registering for the first time, you will need to create and enter a username and password. Please record the username and password that you create as you will need this to log in.

Before completing this form, you will need to make your $10 payment. Payments may be made by EFT or cheque. EFT: MWWC CBA bank BSB: 063 000; Account Number: 0090 0731. Please format the reference of your payment as 'PSubsPreferredNameSurname' for example 'PSubsJaneSmith'. If payment by cheque is desired, please contact the Membership Secretary (This email address is being protected from spambots. You need JavaScript enabled to view it.) for instructions.

Once your payment has been made, please complete the form, and then click SUBMIT to lodge your registration.

Password strength: Please note, when creating your user account, you will be required to choose a password that is at least 8 characters long, including at least 1 of each of the following: numbers, symbols, upper case letters and lower case letters

Account Information

Username*

Password*

Retype Password *

Preferred Name *

Last Name *

Address *

Suburb *

Post Code *

Email *

Home Phone

Work Phone

Mobile phone *

Emergency Contact Name, Relationship, & Mobile *

Year of Birth

Join Year

Photo Consent *

How did you hear about the club? *

Please specify

Health information

Please complete the Emergency Contact and Health Form and carry it in your pack at all times in a sealed plastic envelope. This information is for emergency use only.

Payment Information

Fee

Payment Made By *

EFT

Cheque

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

I have read and understood the requirements outlined in the Acknowledgement of Risk and Obligations of Temporary Members form and wish to join the activities of the Club

Please select here: *

Yes

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