First Name:

*

Last Name:

*

Organisation:

 

Address:

*

Address Line 2:

  (optional)

City/Suburb:

*

State:

ACT NSW NT QLD SA TAS VIC WA Other *

Postcode:

*

 

 

Phone:

* (at least one phone contact)

Fax:

Mobile:

Email:

*

 

 

DOB

 (required format: dd/mm/yyyy)

 

 

Membership Type: 

  Women aged 18+ - Voting (Price: $22.00) Concession - Voting (Price: $11.00) Men aged 18+ - Non-Voting (Price: $22.00) Concession - Non-Voting (Price: $11.00) Under 18 With Parental Consent - Non-Voting (Price: $0.00)

Registration Type: 

  New Renewal

 

 

Donation:

In addition to my membership, I would like to donate
the following 

 

 

 

 

 I will uphold the values and purpose of the YWCA of Adelaide

 

I give YWCA of Adelaide permission to use photos taken of me during Walking Club activities

 

I am aware that during Walking Club activities, certain risks are inherent.  I do hereby assume all considered risks and will render the YWCA of Adelaide and all persons, corporations and bodies involved or otherwise engaged in promoting or staging activities harmless from any and all liability.  I also understand that, in the interests of personal and/or group safety cohesion, the Walking Club leaders, instructors and coordinators reserve the right to withdraw any participant(s) during the activity.

Emergency Contact:

(Full Name)

Phone:

*

Mobile: