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Offline Membership Form

2011 New Member Application Form

You can also download our membership form, complete all relevant details and return to SAJC Membership, PO Box 707, Park Holme 5043, Fax to (08) 8294 1113 or email membership@sajc.com.au

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Become a Member - Join Online

Title^*
First name e.g. Robert
Preferred name^* e.g. Bob
Last name^*
Suffix
Gender^*	Male Female
Date of birth^*	//
Company
Profession^*
JobTitle
Home phone^*
Work phone
Mobile
E-mail address^*
Allow the SAJC to contact me via e-mail
Postal address
Street address 1^*
Street address 2
Suburb^*
State^*
Postcode^*
Residential address
Same as postal address
Street address 1^*
Street address 2
Suburb^*
State^*
Postcode^*
Membership details
Category^*	Young Member $156 Aged between 18 - 35 years Adult Member $312 Aged between 36 - 69 years Senior Member $216 Aged 70 years or over Country Member $216 Reside over 100 km from Allan Scott Park Trainer Member $156 Licenced Trainer Trainer - Country Member $108 Reside over 100km from Allan Scott Park Trainer - Young $78
Additional Annual Members Guest Pass	$228.00 Can only be purchased by a Member
Proposer/seconder details Please complete the details of the Proposer/ Seconder if you know two financial members of the South Australian Jockey Club. If not, the Board upon receipt of this application, will at the time consider to act as Proposer and Seconder of your application.
Proposer
First name
Last name
Phone number
Membership no
Seconder
First name
Last name
Phone number
Membership no
Identification Please upload a scan (up to 500KB) of your drivers licence or passport now: Please forward a copy of your drivers licence or passport to: C/O Membership Officer PO Box 707 Park Holme SA 5043 or present documentation to the Secretary's Office
Further details Please include any additional information relevant to your submission.