The Celtic Club - Member Application

Information needed for your membership application.

Please remember to complete all the boxes marked with a *

*Your first name:
*Your last name:
*Mailing address :
*Suburb:
*Postcode:
*State:
*Country:
Phone (a/h):
Phone (work):
Mobile:
*Email:
Occupation:
		My interest in joining the Celtic Club is:
Celtic Interest:

Nominator:		(member of Celtic Club)
		Should you not have a nominator your application will be referred to the President, Mr Seamus Moloughney, for consideration. Overseas applications at the discretion of the committee.
Nominator's contact details:

		If you wish to be in our birthday club please supply your birthday.
Birthday:		(year optional)

Please confirm Please confirm		I desire to become a member of the Celtic Club Incorporated. In the event of my admission as a member, I agree to be bound by the rules of this Association for the time being in force. Our Club's Annual Report will be available each year to members via our Website. Should you require a written copy please notify us by checking the box. Yes/No




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