General 4 — Jingellic Showgrounds

Benefits of Membership:

Membership Option

Adult $10 (18 years and over)

Number of Adults

Name/s of Members

Please list first and last name of all members joining on this form

Postal Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Email

Children under 18

Children under 18 are free, please list their names and ages below

Your membership fee contributes to the upkeep of our facilities and grounds.

Payment can be made by direct deposit, Cheque (made out to Jingellic Hub Inc.) or cash

Direct Debit information:

WAW Credit Union

BSB: 803 070

Account: 1000 217 58

Reference: Surname