|
|
* – mandatory fields
|
|
Membership Fee: $55.00 per annum, Total: $55.00
|
| |
| Membership Type* |
Membership type is required
|
| Title: |
Please select title
|
| Gender |
|
| First Name* |
First name is required
|
| Last Name* |
Last name is required
|
| Date of Birth* |
Date of birth is required
Please re-apply when you are 18, and in the interim you can attend with the Committee/Activity Leader's permission as a Visitor
Date is not valid
|
| Work Phone |
Work Phone Must Be 8 Digits Long.
|
| Home Phone |
Home Phone Must Be 8 Digits Long.
|
| Mobile Phone |
Please enter a valid Mobile Phone number.
|
| Email* |
Please enter your long-term, stable, private email address as it will be used as your login, so it is desirable to have one that won't change, ie not a work email. Email is required
Invalid Email Address
|
| Occupation * |
Occupation is required
|
|
1. |
Do you undertake any endurance exercise (20mins+) on a regular basis?
|
Please select answer
|
|
2. |
What type of endurance exercise do you engage in?
|
Please select answer
|
|
3. |
Have you ever done any bushwalking in the last 6 months?
|
Please select answer
|
|
4. |
Have you done any overnight bushwalking carrying a backpack (around 12 kg)?
|
Please select answer
|
|
5. |
How do you rate your walking fitness?
|
Please select answer
|
|
| Paid Amount* |
Paid amount is required
Numeric values only.
|
| Payable Bank* |
Payable bank is required
|
| Paid Date* |
Paid date is required
|
| Pay Mode* |
|
|
Transaction ID
* |
Transaction ID/Cheque No is required
|
| User Password* |
Password is required
Minimum password length is 6
|
Confirm User Password*
|
Please confirm your password
Passwords must be identical
|
| Address Line 1 * |
AddressLine 1 Required
|
| Address Line 2 |
|
| Post Code * |
Postcode Required
|
| Suburb * |
Suburb Required
|
| State * |
State Required
|
| Country * |
Country Required
|
|
|
| Address Line 1 |
|
| Address Line 2 |
|
| Post Code |
|
| Suburb |
|
| State |
|
| Country |
|
| Emergency First Name* |
Emergency first name is required
|
| Emergency Last Name* |
Emergency last name is required
|
| Emergency Contact Phone* |
Emergency contact phone is required
Please enter a valid Emergency contact number.
|
| Emergency Contact Email |
Invalid Email Address
|
| Emergency Contact Relationship* |
Emergency contact relationship is required
|
| Vehicle Registration |
|
| Vehicle Type And Color |
|
Carrying Capacity
(Driver plus 1, 2 or 3 passengers with bushwalking gear) |
|
|
Qualification
|
|
|
Level
|
|
|
Valid Till Date
|
Entered date must be greater than current date
|
In order to facilitate communication amongst members, when organizing attendance at SBW activities, we publish a Membership List (including name, suburb and phone numbers). This information is updated each year, and sent to all the Members, on the basis that details are not promulgated beyond the club. Our Members are very respectful of this. We have therefore made the "default" in the Database that Members are listed in the Membership List.
If you do not want this to occur please check the box:
|
|
Please complete our anti-spam security sum:
|
|
*Required
Invalid value.
|
By submitting this form, you acknowledge the following. All participants, including visitors, are reminded that they join in activities as volunteers. Your fitness is your responsibility. Bushwalking and other activities on our program have associated risks including but not limited to the risk of accidental injury.
All persons joining in any activities of the Sydney Bush Walkers Inc. do so as volunteers in all respects and as such accept sole responsibility for any injury howsoever incurred and the Sydney Bush Walkers Inc, its office bearers and appointed leaders are absolved from any liability in respect of any injury or damage suffered whilst engaging in any such activity
|
You must select this box to proceed.
|
|
|
