Eastern Suburbs Rugby League Past Players and Officials Association Incorporated

Eastern Suburbs Rugby League Past Players and Officials Association Incorporated

31 Panitya Street Stones Corner 4120 Email: ppo@thetigers.com.au
I hereby apply for membership in the Easts Past Players and Officials Association Inc.
I agree to abide by all rules and regulations as set out in the constitution of the Association.
Lifetime membership fee of $20.00. Payment Methods: EFT or Cash
Account Name: Eastern Suburbs

BSB: 034033

Account Number: 445562

Ref: Your Name
Payment has been made*

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I was an active Player/Official with one of the following Clubs for the period shown (the minimum period acceptable is one football season as a registered Player or one year as a recognised Official).*

Eastern SuburbsEastern Suburbs JuniorsEasts CarinaEasts Mt GravattEasts SpringwoodEasts East BrisbaneBulimba EastsRochedale Tigers
Please state the year/s that you were involved with the Club and also your position in the Club (E.g.Player Under 15 1962, or Manager Under 18 1985):*
Name*

First NameLast Name
Address*

Street Address

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Postcode
Phone Number*

Area CodePhone Number
Email*
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Signature*

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DOB*

DayMonthYear
Date of Birth
Date

DayMonthYear
Today's Date
Proposed By

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Seconded By

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Approved / Rejected at EPP&O Committee Meeting dated
Receipt Number
Date
Membership Number
Membership Card and receipt mailed /Type a question delivered
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Eastern Suburbs Rugby League Past Players and Officials Association Incorporated

Official Use Only