Membership Form

Please tick membership required

Junior $10.00	Senior $25.00	Couple $50.00	Family $55.00

Permission is given to HB Rock n Roll club to publish photos taken at club events on the club website.

Name:

Partners Name:

Address:

Birth Month:

Partners Birth Month:

Phone number:

Mobile Number:

Email Address:

Children:

Birth month:

Children:

Birth month:

Children:

Birth month:

Please note:

Couple/Family memberships will only receive one set of mailed/emailed correspondence i.e. Newsletters, AGM notices, etc.

GST is not included as the Club is not GST registered.