MALADICTION LONGBOARDERS Victoria, Inc.

MEMBERSHIP APPLICATION 2001

Print off this form, fill it out and send it together with the appropriate amount to:
MALADICTION LONGBOARDERS VIC.INC.

PO Box 37 

Flinders

3929
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Name:
Address:
Date of Birth:
Email Address:
Home Phone:
Work Phone:
T-Shirt Size

 

Joining Fee Renewal Fee

Family $65

 Family $50

Single $55

 Single $40

Junior $30

 Junior $15

 

Joining fee includes one Club T-Shirt

Size M L X

Additional T-Shirts available at $20

Size M L X Number required