Name:

Street:

Town: State: VIC ACT NSW NT SA TAS WA Postcode:

Phone No: Email:

Membership Details

Member 1:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Member 2:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Member 3:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Member 4:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Member 5:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Member 6:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Member 7:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Member 8:

Family Name: Given Names: Year of Birth: SI Number (blank if not applicable):



Comments:


Payment Details

If paying by Cash, do not send cash by post. Visit the Eureka Cake Stall or find a Eureka Member at an event.

If paying by Direct Debit, go to your online banking website, and choose the option to Pay Anyone. Deposit correct total amount to Account Name: Eureka Orienteers BSB: 063 556 Account Number: 1005 5562. Include your family name plus "Membership" in the reference field, so we can cross-reference your payment with your entry.

If paying by Cheque or Money Order, please make your cheque or MO out to Eureka Orienteers Inc. and either post it to Eureka Orienteers, PO Box 490, Ballarat VIC 3353, or visit the Eureka Cake Stall or find a Eureka Member at an event.

Payment Method: Cash (Pay at event - Do not post!) Direct Debit Cheque Money Order Total Amount:

Enter the text shown below into the text box: Submit Form

Click the Submit Form button to email your membership to the club. See you at the next event!




Click the Reset Form button to clear the form and start over...