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Application - Postgraduate Membership

Application Form - Postgraduate UWA Student

Postgraduate Membership is available only to CURRENT postgraduate students of UWA. Confirmation of current enrolment in UWA Postgraduate studies must be proven in order to be eligible for Postgraduate Membership. This category of membership is fixed term to expire 12 months after you join. You will be contacted at the start of the month you are due to expire in and if we do not hear back from you the membership will be automatically cancelled on the last day of that month. Please complete this application form allowing 2 business days to process. The University Club respects your privacy and all information provided by you will remain confidential.

Applicant Details

UWA Student Number *

Are you a current or past University Club Member? *

Yes

Member Number (Please Provide Member Number If you are a current or past University Club Member)

Title

First Name *

Last Name *

Preferred Name *

Street Address *

City (Suburb) *

State *

Postcode *

Country *

Email *

Telephone Number *

Date of Birth *

Club Account and Signing Privileges 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

The Club provides signing privileges through a credit facility for all Members allowing charging food, beverage and event expenditure to their Club account. To set up a Club Account, it is mandatory that Members provide the Club with details of a nominated credit card or transaction account from which these charges can be debited. If you choose to pay your subscription by credit card or direct debit then this account will also be used for payment of incidental charges. Settlement of incidental expenditure is by direct transfer from a nominated credit card or transaction account on or around the 20th of each calendar month. A statement of account will be issued to you in the first week of each calendar month for any membership subscription and incidental charges.

Settlement Details

Please provide your preferred payment method. We do not capture card or bank information on form. We will reach out to you to confirm card details in person.

Please nominate your preferred payment method. *

Direct Debit from a nominated bank account

Credit or Debit Card

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 understand the Terms and Conditions of Membership and the information provided on this form 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. *

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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Form Designer

Application - Postgraduate Membership

Application Form - Postgraduate UWA Student

Applicant Details

Club Account and Signing Privileges Request

Settlement Details

Ezidebit account payment Terms and Conditions - Click Here To View

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Sub Navigation

Form Designer

Application - Postgraduate Membership

Application Form - Postgraduate UWA Student

Applicant Details

Club Account and Signing Privileges Request

Settlement Details

Ezidebit account payment Terms and Conditions - Click Here To View