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First name

Last name

Email

Phone (+61 4xx xxx xxx)

Membership Level

Family Membership $60

Single Membership (>18 yrs) $40

Junior Membership (15 - 17 yrs) $22

Associate Membership (<15 yrs) $22

Date of Birth (required for Junior & Associate members)

Other Information

Payment may be made by Direct Deposit Account Name: Bunbury Musical Comedy Group Account Number: 1106-1330 BSB: 066-507

Please include your full name in the payment details.

Membership is not official until payment has been received.

By submitting this form, you agree to abide by the rules as laid down in the Constitution of Bunbury Musical Comedy Group Inc. (A copy of the Constitution can be requested via email)

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