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Application Form - Family Membership

To apply for the Family membership category, please complete the application form below. Please note that each family nominee appointed to this membership must complete an online Family Nominee application form. The University Club respects your privacy and all information provided by you will remain confidential. Please allow 2 business days for the Membership Team to process this application.

Family Membership - Primary Nominee

Are you a Current University Club Member? *

Yes- Please provide your Membership number and Name below then continue with the application.

No - Please proceed below with this application.

Member Number (Only complete if you are a current Club Member)

Primary Member Details

Family Memberships are required to have a full fee-paying Member appointed as the Primary Member. Primary Members are required to pay a one-off $385.00 joining fee in addition to either an annual subscription fee (currently $353.00/annum) or monthly subscription fees (currently $29.42/month via automatic direct debit from a nominated bank account or credit card) Current University Club Members transitioning to Primary Membership on the Family category of Membership are not required to pay the joining fee, however, the subscription fee may change based on the original category of Membership.

Title *

First Name *

Last Name *

Preferred First Name

Date of Birth *

Street Address *

City (Suburb) *

State *

Postcode *

Country *

Email *

Telephone Number *

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

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

Incidental charges are settled via automatic direct debit on, or the nearest business day following, the 20th of each month.

Please nominate your preferred payment method. *

Direct Debit from a nominated bank account

Credit or Debit Card

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.

Family Nominees

Please list the name and relationship to the Primary Nominee of each person who is to be appointed to the Family Membership. IMPORTANT: In addition to the Primary Member, a minimum of 1 Family Nominee is required to qualify for a Family Membership. A subscription fee of $180.00/annum OR $15.00/month is to each family nominee appointed to the Family Membership.

Each Family Nominee will be required to complete an online Family Nominee Form

Please Click Here for the Family Nominee application form

NOMINEE 1

Title *

First Name *

Surname *

Relationship to Primary Member *

NOMINEE 2

Title

First Name

Surname

Relationship to Primary Member

NOMINEE 3

Title

First Name

Surname

Relationship to Primary Member

NOMINEE 4

Title

First Name

Surname

Relationship to Primary Member

NOMINEE 5

Title

First Name

Surname

Relationship to Primary Member

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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Application Form - Family Membership

Family Membership - Primary Nominee

Primary Member Details

Club Account Request

Settlement Details

Family Nominees

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Sub Navigation

Form Designer

Application Form - Family Membership

Family Membership - Primary Nominee

Primary Member Details

Club Account Request

Settlement Details

Family Nominees