New Members

New Member

Please note that filing out this membership form is to receive a membership for Kambah only at this time.

Becoming a member of the Burns Club is easy and if you are interested in becoming a member of the Burns Club, you can either fill out this form or sign up whenever you are in the club next.

Just a friendly reminder that the concession prices are for pension and concession card holders only.

*Please allow a minimum of 24 hours before collecting your membership card.

"*" indicates required fields

Name*

First Last

Phone*

Email*

Date of Birth*

Residential Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Age restriction*

You certify that you are over eighteen (18) years of age.

Privacy Policy*

You have read and understood the Privacy Policy

Product Name*

Total

Credit Card*

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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