Ipswich Turf Club Application for Membership

Membership Type

Membership Fees *

Ordinary Annual Membership $ 175 per annumConcession Annual $ 125 per annum

ADDITIONAL FEES
All new Membership Applications $50 Application Fee
Membership/Guest Tag Replacement Tags $50 per Tag

Your Details

First Name *

Last Name *

Date of Birth *Scroll to set your date of birth

Email Address *

Postal Address *

Suburb *

State *

Postcode *

Phone

Mobile *

Occupation

Business Name

Post or Collect Badges *

PostCollect

Proposer/Club Secretary

Proposer First Name

Proposer Second Name

Proposer HistoryHow long have you known the candidate?

Proposer AddressEnter your address in full

Seconder (if required)

Seconder First Name

Seconder Surname

Seconder HistoryHow long have you know this candidate?

Seconder AddressEnter your address in full

Other Members

Other members of the Club to whom you could refer if required are named hereunder.

Referring Members

Yes, I know other membersNo, I do not know any members

Member 1

Member 2

Other Memberships

List any Racing Clubs which the Candidate is a Member

Racing Club 1

Racing Club 2

List any Other Clubs which the Candidate is a Member

Other Club 1

Other Club 2

History

Have you ever been convicted of any criminal offence?

Criminal Offences *

NoYes

Please explain further

Terms & Conditions

I agree to my nomination and hereby apply for membership to the Ipswich Turf Club. If elected, I agree to abide by the Rules of the Club for the time being in my force. I declare that the answers by me to the foregoing questions are true and correct and that I have not withheld information within my knowledge. I hereby agree that I am not aware of any situation or reason that would prohibit me from becoming a member of the Club.

I agree that my personal information may be used by the Club for business and marketing purposes. I hereby agree to the ITC Privacy Policy available online here

*

I hereby declare that I have read and agree to the ITC Conditions of Entry available online here.
*

I confirm I am 18 years and over

*

Candidate Signature *

Draw signature|Type signatureClear

Enter the date *

Process your payment

Membership Due$50 Application Fee applies for new applications

Payment *

Pay

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