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Membership Application

Membership

Membership Application form

Step 1 of 2

Please Select Membership Type(Required)
Name(Required)
Address(Required)
Date of birth(Required)
Are you now, or have you ever been, subject to disciplinary action by the Canberra Labor Club resulting in suspension or cancellation of any membership?(Required)
Do you have a gambling problem, been excluded from a gambling facility under a deed of exclusion or been questioned by an authorised Gambling Contact Officer regarding a potential gambling-related problem?(Required)
Consent(Required)
Consent(Required)
Consent(Required)