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JUVE 500 Club Qty____ @ $500 each (inc GST) Total $__________

“BACK TO BASICS – WERE COMING HOME” 2013 MORELAND ZEBRAS MEMBERSHIP APPLICATION AND RENEWAL FORM ABN: 31-206-809-466. We need your financial and vocal support in 2013!!! 2013 JUVE 500 Club Privileges - Entry to all home games and VIP privileges

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JUVE 500 Club Qty____ @ $500 each (inc GST) Total $__________

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  1. “BACK TO BASICS – WERE COMING HOME”2013 MORELAND ZEBRAS MEMBERSHIP APPLICATION AND RENEWAL FORMABN: 31-206-809-466 • We need your financial and vocal support in 2013!!! • 2013 JUVE 500 Club Privileges • - Entry to all home games and VIP privileges • - Invitation for member and guest to Club’s Presentation Night • - Free car parking. - Voting Rights at Annual General Meeting • 2013 JUVENTUS Club Support, Full, Pensioner and Life Membership Privileges. • - Entry to all home games - Free car parking. - Voting Rights at the Annual General Meeting • N.B: • Life members will be entitled to voting rights on payment of a $100 fee. • All junior registrations receive automatic membership – 1 membership (vote) per family. JUVE 500 Club Qty____ @ $500 each (inc GST) Total $__________ Juventus Support Club Qty____ @ $250 each (inc GST) Total $__________ Full Membership Qty____ @ $100 each (inc GST) Total $__________ Pensioner Membership Qty____ @ $80 each (inc GST) Total $__________ Life Members Fee Qty____ @ $100 each (inc GST) Total $__________ Existing Member New Member Juniors Member (Please tick box) Mr/Mrs/Ms/Miss Surname: …………………………………...…………………….. Given name:…….………………………….…………………………….. Address:……………………………………………………………………………………..... . Suburb: …………………………Post Code: …………Occupation………..………...…. Tel: Bus: ……………………....A/h: ……………...……….Mobile: ………………………. E-mail address…………………………………………………………………………………... Signature: ……………………… ……………………Dated: ………………………………. Paid: Cash / Cheque Payable to: Brunswick Juventus Football Club Inc. P.O. Box 783 LPO 132 Elizabeth Street, Coburg. VIC. 3058. Banking Details: ANZ Bank BSB: 013-270 Account No: 4793-02843 Proposed by: …………………Seconded by…………..…….. Accepted …………………….. Card/Membership no:…………….. All prices quoted include GST.

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