Applicant Details Name *
Mr. Mrs. Miss Ms. Dr. Prof. Rev. Prefer not to say
Preferred Name * UWA Student Number *
If you do not know your student number please advise in the box above and include the year of graduation and the name studied under.
Date of Birth *
DD slash MM slash YYYY
* Email *
Primary phone number * Members Parking Bays - Vehicle Details
Please complete this section if you wish to receive a parking permit for the University Clubs Members parking bays.
Please note that parking fees apply, are subject to availability and can only be used when visiting the Club.
Registration number Car make and model 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 * Settlement Details
Membership subscription fees are paid monthly by automatic direct debit
Please nominate your preferred payment method *
Please provide your preferred payment method.
If you wish to pay via a credit or debit card, please do not provide details in this form. We will contact you to confirm card details in person.
Name and branch of your financial Institution BSB Number Account Number Account Name Terms and Conditions of Membership
Young Alumni Membership
To qualify for Young Alumni Membership the applicant must be aged 35 years and under. Proof of age must accompany
this application. Acceptable identification includes a current drivers licence, current proof of age card, current passport
or birth certificate.
Suspension of Membership
It is agreed that I may suspend my Membership for a minimum of three (03) to a maximum of twelve (12) months
throughout the duration of my Membership. All outstanding dues and food & beverage charges will be settled prior
to my Membership being suspended, and I agree to provide correct contact details valid for the duration of the
Membership suspension. It is agreed that I may suspend by giving no less than thirty (30) days advance written notice.
Cancellation of Membership
I agree to maintain my Membership for a minimum period of six (06) months. It is agreed that I may cancel my
Membership by giving no less than thirty (30) days advance written notice and payment of all outstanding dues and
charges. It is also understood that dues and charges owing may not be offset against the Joining Fee paid by the
I agree to carry and present my membership card when visiting the Club.
Assumptions of Liability
It is understood that subject to The University Club By-Laws and Regulations, and those that may be enforced from
time to time, The University Club of Western Australia shall determine the dues that will be charged to Members.
Membership of the Club does not confer upon me any ownership or liability for the property and assets owned by
the Club. I agree that I am responsible for the charges incurred by me and my guests in the use of the facilities and
amenities of The University Club of Western Australia.
I have read and understand both the Terms and Conditions of Membership and the “Important Information for Prospective Members” information sheet 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
Name Date Thank you! We look forward to welcoming you to the Club as a Member