Membership No. *  
First Name *  
Last Name *  
Date of Birth *
 
 
Contact No. *    
Email *   
Purchase receipt will be emailed to you
Residential Address *  
Suburb *    
Postal Code *    
State *
Postal Address
Suburb  
Postal Code  
State

     all fees listed include GST
Should we mail your card to you or hold it at the club for collection?
Please note: Payment for renewals are processed within 2 working days of submitting this form. If we are holding the card at the club for collection, please allow 2 working days for the card to be available for pickup. Alternatively, if we are posting the membership card, please allow 2 working days plus additional time for postage. If your renewal is urgent, please phone reception on 8868 9200 or visit club reception for immediate processing.
I wish to receive exclusive information about Wenty Leagues Club gaming promotions in conjunction with food and beverage promotions and offers
My Preferred method of contact is

Credit Card No.
Exp Date
 
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