Leeming Bowls & Recreation Club (Inc.)
Dimond Court, Leeming, WA 6149
Telephone: 93105400 Fax: 93322306 Email: [email protected]
MEMBERSHIP APPLICATION
First Name(s) Surname
House Number and Street Name
Suburb Post Code
Home Telephone Mobile Number
Email Address
Male Female Date of Birth
CATERGORY OF MEMBERSHIP REQUIRED
Ordinary Junior
Restricted Restricted Junior
Social Country Member
Dual Capitation Other
LAWN BOWLS HISTORY AND INFORMATION
Club’s Name
Are you an accredited Coach, Umpire or Measurer – If so, please enter details below
Coach Details Umpire Details Measurer Details
VERIFICATION
Applicants Signature Date
Proposer Signed
Co-Proposer Signed
Are you subject to any expulsion, suspension or termination conditions?
Have you played Lawn Bowls previously?
If so, please give details of the most recent Bowling Club of which you were a member.
Yes No
Reg No. Expiry
Reg No. Expiry
Reg No. Expiry
Yes No
