Address: 662A Old Northern Rd, Dural NSW 2158 Phone: (02) 9651 1600 Membership No. Card Expiry Date DD slash MM slash YYYY Personal DetailsTitleMr.Mrs.Ms.MissGiven names(Required) Date of Birth(Required) DD slash MM slash YYYY Surname(Required) Occupation(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code Contact DetailsMobile(Required)Home Phone(Required)Email(Required) Consent I consent to receiving gaming promotion communicationsDeclarations and Consent 1. I agree to abide by the Constitution and By-laws of the Club. 2. I acknowledge that in some cases it is mandatory for the Club to send constitutional updates and notices to all members. 3. I understand that this information above can be used by the Club for marketing purposes. The data collected will be handled sensitively, securely and in compliance with the Privacy Act requirements. Signature of Applicant(Required)Date(Required) DD slash MM slash YYYY
