Sunset Social membership form

Complete The form below

Thank you for your interest in becoming a Sunset Social member and supporting Coogee Beach Surf Lifesaving Club. Please fill in the details below, we will process your payment then we will arrange your new membership card which you can collect the next time you visit the club. We look forward to seeing you!

Surname*

First Name*

Date of Birth

GenderMaleFemaleUndisclosed

Occupation*

Phone*

Email*

Address*

I acknowledge and agree to abide by all aspects and conditions of SLSA, and Coogee Beach SLSC Membership, in making this Membership application. Key aspects and conditions of SLSA membership are available from the Club Office, 20 Poore Grove COOGEE WA 616.I warrant that all information provided is true and correct.

I agree

Date*

Credit Card payment details:

Card Number*

Exp date*

CCV*

Preferred Contact MethodEmailPhone

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