2019 Non-Player/Social Membership Application Form Non-Player/Social Membership Application NAME* First name Surname Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender* Male Female Address* Street Address Suburb State Post Code Home phoneMobile phone*Email*Please enter these details carefully as this is the address that your confirmation email will be sent to. Enter Email Confirm Email OccupationNON-PLAYING MEMBERSHIP TYPE*Please indicate the type of non-playing membership that applies to you. Social Member Honorary - Parent of Junior under 16 Life Member Fees*All non-player membership fees due are to be paid in full on registration. For more information on payment arrangements please refer to the fees page on the website here. Please select the relevant fee rate from the drop down menu below. SocialHonoraryLife MemberMETHOD OF PAYMENT*Please indicate how you will be paying your 2019 fees. Direct Deposits should be made to the SRHC Bank Account BSB 633-000 A/C 1479 41421. Please use the Payment ID and your child's surname as the reference.Cash/Cheque/EFTPOSDirect Credit to SRHC Bank AccountDirect Debit Arrangement from my Bank AccountDECLARATION* I accept Southern River Hockey Clubs' codes of conduct and have read the relevant information as provided within this application. Total $ 0.00 PhoneThis field is for validation purposes and should be left unchanged.