Membership Application

All fields are required.

All information must be true and correct. Incorerect or misleading information may result in non-acceptance.

Field is required!
Field is required!
Application type
  • - select a option -
  • Patched Member
  • Supporter
  • Social
- select a option -
Field is required!
Field is required!

Please note that there is a probationary period of six (6) months (or sooner) after acceptance before members vote to fully accept you in to the club.

Field is required!
Field is required!

Please note that this category is specific to members friends and family. If you are not a family member or friend of a Patched Member, please choose either "Patched Member" or "Social" member.

Field is required!
Field is required!

Please note that this membership type is for persons who are not Family or Friends of Patched Members. Please read the Membership restrictions for this membership type.

Field is required!
Field is required!
Application sponsor
Sponsors Full Name
Field is required!
Field is required!

Personal details

Given Name
Your First Name
Field is required!
Field is required!
Preferred nickname
Your preferred nickname
Field is required!
Field is required!
Mobile number
Your Mobile number
Invalid phonenumber!
Invalid phonenumber!
E-mail address
Your E-mail Address
Field is required!
Field is required!
Surname
Your Last Name
Field is required!
Field is required!
Home number (if applicable)
Your Home number
Invalid phonenumber!
Invalid phonenumber!
E-mail address confirmation
Your E-mail Address
Field is required!
Field is required!
Address
Your Address
Field is required!
Field is required!
City/Suburb
City/Suburb
Field is required!
Field is required!
State
  • - select a option -
  • ACT
  • NSW
  • QLD
  • VIC
  • TAS
  • NT
  • SA
  • WA
- select a option -
Field is required!
Field is required!
Postcode
Postcode
Field is required!
Field is required!
Marital Status
Field is required!
Field is required!
Accommodation options
Field is required!
Field is required!

Next of Kin details (NOK)

Given Name
Your First Name
Field is required!
Field is required!
Moibile number
NOK Moibile number
Invalid phonenumber!
Invalid phonenumber!
Surname
Your Last Name
Field is required!
Field is required!
E-mail address
NOK E-mail Address
Field is required!
Field is required!
Address
Your Address
Field is required!
Field is required!
City/Suburb
City/Suburb
Field is required!
Field is required!
State
  • - select a option -
  • ACT
  • NSW
  • QLD
  • TAS
  • VIC
  • NT
  • SA
  • WA
- select a option -
Field is required!
Field is required!
Postcode
Postcode
Field is required!
Field is required!

Vehicle details

Vehicle type
  • - select a option -
  • Car
  • Motorcycle
  • Truck
  • Push bike(E)
  • Scooter
  • Public Transport
- select a option -
Field is required!
Field is required!
Insurance
  • - select a option -
  • Full Comprehensive
  • 3rd Party Only
  • Full & 3rd Party
- select a option -
Field is required!
Field is required!
Add another vehicle
Field is required!
Field is required!
Make
Vehicle Make
Field is required!
Field is required!
Vehicle model
Vehicle model
Field is required!
Field is required!

Secondary vehicle

Vehicle type
  • - select a option -
  • Car
  • Motorcycle
  • Truck
  • Push bike(E)
  • Scooter
  • Public Transport
- select a option -
Field is required!
Field is required!
Insurance
  • - select a option -
  • Full Comprehensive
  • 3rd Party Only
  • Full & 3rd Party
- select a option -
Field is required!
Field is required!
Make
Vehicle Make
Field is required!
Field is required!
Vehicle model
Vehicle model
Field is required!
Field is required!

Military Details

Service
  • - select a option -
  • Navy
  • Army
  • Airforce
- select a option -
Field is required!
Field is required!
PMKeyS number
Your PMKeyS number
Field is required!
Field is required!
Enlistment date
Select a date
Field is required!
Field is required!
Branch/Corps
Branch/Corps
Field is required!
Field is required!
Regimental number (if applicable)
Your Regimental number
Field is required!
Field is required!
Separation date (if applicable)
Select a date
Field is required!
Field is required!
Years of service
Years of service
Field is required!
Field is required!
Current rank
  • - select a option -
  • First choice
  • Second choice
  • Third choice
- select a option -
Field is required!
Field is required!
Separation reason
  • - select a option -
  • Administration
  • Medical
  • CRA
  • Soldier initiated
- select a option -
Field is required!
Field is required!
Postings
Your postings
Field is required!
Field is required!

Honours & Awards

Medals
Field is required!
Field is required!
Other medals
Other medals
Field is required!
Field is required!

Commendations & Badges

Field is required!
Field is required!
Other Commendations & Badges
Other Commendations & Badges
Other Commendations & Badges
Field is required!
Field is required!
Tell us about your career (optional)
Tell us about your career...
Field is required!
Field is required!

Disclaimer

I agree to the rules, by-laws and constitution of the Townsville Veterans, furthermore, I understand should I be accepted that I am to undergo a probationary period of six (6) months (may be less). I understand that during this time should I be found unacceptable that I will be removed from the club.

Field is required!
Field is required!

I am aware that my sponsor or patched family member is responsible for my conduct. I am aware that I will be asked to leave the club should I be found to be brinmging the club in to disrepute. I understand that I have no voting rights.

Field is required!
Field is required!

I am aware that my sponsor or patched family member is responsible for my conduct. I am aware that I will be asked to leave the club should I be found to be brinmging the club in to disrepute. As a social member I understand that I have no voting rights or voice within the club.

Field is required!
Field is required!
Acknowledgement
Field is required!
Field is required!

PLEASE DO NOT SUBMIT THIS APPLICATION - IT WILL NOT BE ACTIOND AS YOU HAVE NOT AGREED WITH THE ABOVE STATEMENT.

Field is required!
Field is required!

Payment

If your application date falls within the first week of the month there is no pro-rata, full fee of $50 is required.

If your application date falls within the second, third or fourth week of the month, the pro-rata fee of $25 is required.

Once you submit the application you will be redirected to paypal where you can pay with various options.

Field is required!
Field is required!
  • - select a product -
  • Patched Member
  • Patched Member (pro-rata)
  • Supporter Member
  • Social Member
- select a product -
Required
Required
-
+
Field is required!
Field is required!
$0.00
Field is required!
Field is required!
Submit Now