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Corporate Delegate Membership

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Application - Corporate Delegate

Company Name *

ABN *

Title *

First Name *

Last Name *

Preferred First Name *

Are you a current or past University Club Member? *

Yes

Date of Birth *

Street Address *

City (Suburb) *

State *

Postcode *

Country *

Telephone Number *

Email Address *

Occupation

Subscription payment details - please nominate your preference. *

Please contact me for payment details.

Please send an invoice for direct payment.

Club Account Request - Members with valid payment details on file are able to charge incidental expenditures such as food and beverage purchases and member events to their Member accounts *

Yes, I would like a Club Account.

No, I would not like a Club Account.

If you choose to have a Club Account our team will be in contact to add your payment details to your account. We do not capture card or bank information on form.

Ezidebit account payment Terms and Conditions - Click Here To View

I authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID 342190, 428198) (“Ezidebit”) to debit payments from my account, at intervals and amounts by The University Club of Western Australia Pty Ltd (“The Business”)as per the Terms and Conditions of my agreement with the Business and in accordance with this Direct Debit Request and the DDR Service Agreement.

Declaration - Terms and Conditions - Click Here To View

I have read and understood the below Terms and Conditions of Membership and agree that acceptance of the Membership application implies that I accept the By-Laws and Regulations of The University Club. I also fully understand that the Membership Sub-Committee reserves the right to approve or reject my application without assigning any reasons whatsoever. Yes

Consent - Code of Conduct - Click Here To View

I have read and agree to The University Club of Western Australia Member's Code of Conduct as set out in the link above.

Full Name: *

Date: *

Thank you. We look forward to welcoming you to the Club as a Member!

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Application - Corporate Delegate