Subscribe for Adult - Ballarat Bushwalking and Outdoor Club (Inc)

New Member Application form

I would like to become a member of the Ballarat Bushwalking and Outdoor Club (Inc). Should I be accepted, I agree to be bound by the constitution of the club and the club rules.

For EFT Payments, Send your payment amount to:

Ballarat Bushwalking and Outdoor Club

BSB: 313 140

Acc: 1249 1888

Account Information

Email *

Desired Password*

Retype Password *

First Name *

Surname *

Mobile phone

Other Phone

Residential Address *

Suburb *

Post Code *

Identify your age category

Emergency Contact Name & Mobile

Children Under 18

Click to view Club Risks and Responsibilities

I accept the Risks and Responsibilities *

Yes

Payment Information

Price

Payment Method *

Paypal

Electronic Funds Transfer (EFT)

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*