Become A Member | Port Beach Polar Bears

Membership Application Form

PORT BEACH POLAR BEARS (Inc)

First Name

Last Name

Address

Address Line 1

Suburb

Post Code

Mobile Number

Phone Number

Date of Birth

Nominator (current member)

2nd Nominator (current member)

Do you agree to include this date on the monthly birthday list displayed on the clubs’ notice board?

Yes

“By submitting this form, I confirm that the information provided is true and I am applying for membership.”

Yes, I agree

First Name

Last Name

Emergency Contact Number

Additional Comments

A $20 Nomination Fee is payable to Port Beach Polar Bears:

We take occasional photos for club updates. If you’d rather not be in them, please make sure you stay clear of photo groups or camera areas.