Olympic Ice Sports Club Inc
Membership Application

SURNAME...........................................................

FIRST NAME(S)..................................................

DATE OF BIRTH.................................................
(if under 16)

  M / F.......................................

SENIOR ..................................
   
JUNIOR...................................

FAMILY ...............................................................

.............................................................................
Street Address 
      ……………………………………………………..
                         
                              ……………………………………………………..

Phone  ......................................... 
             
E-Mail…………………………………..


Signed………………………………………………

Date…………………………….


Privacy Statement
I consent to the collection of the above details to be used by the Club for the purpose of administration and for it to be retained, used and disclosed for statistical purposes and to pursuing the recovery of any sum owing to the Club by the Applicant. 


2015 Fees:    Individual Adult      $25.00                       Family                      $40.00
        (Up to 2 adults and dependant children)
                      Social                        $10.00

ISSNZ Registration            $30 per skater
      N/A for parents, volunteers, officials.