Title *

Mrs

Ms

Mr

Dr

Rev

Other

Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Residential Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Postal Address

If different to residential address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Terms and Conditions *

I am over the age of 18 years and wish to become an Ordinary Member of The Brighton Le Sands RSL Club and request that you enter my name on the Registrar of Members accordingly. I agree to be bound by your Constitution and any rules. regulations or oy-laws of the Club from time to time that are in force. I understand that membership is not transferable and any fee, or any part thereof, is not refundable.

I agree to have my details saved