Online Membership Registration Form - Helensvale Pacific Pines Hawks Cricket Club

Player First Name

Player Last Name

Preferred Email Address

^ Please enter your preferred email address

Date Of Birth

Street Address

Suburb

Post Code

Phone Number

Alternative Phone Number

Previous Cricket Club played for and when (if applicable)

How Did You Hear About Us?

^ Please enter how you heard about us. e.g. Google, a friend, facebook, a road sign etc.

Membership Plan Selection

$430 Seniors - (when paid in full now) - No other discounts apply

$430 Seniors - (from 1/09/17) - $215 Initial Payment NOW and $215 follow up payment before 1/1/2018. No other discounts apply.

$95 Over 40s - (plus $20/day includes lunch)

$295 Junior U15, U17 (includes team photo, medal & end of season presentation)

$250 Junior U11, U12, U13, U14 (includes team photo, medal & end of season presentation)

$180 Junior U10 (includes team photo, medal & end of season presentation)

^ Please select the membership plan the player is eligible for. For Juniors, the age you are at August 31 this year, determines what age group you are in. For example, if you are 12 at August 31, you are in U13s. All membership plans include Club White Playing Shirt and Cap, as well as covering ball, umpire and insurance costs. Any full paying senior playing Over 40s, pays $20/day.

If registering player is under 18 years of age, please complete the below Guardian information fields.

Guardian(s) Name(s)

Guardian(s) Contact Number(s)

Guardian(s) Preferred Email Address

Available Discount Options - Juniors Only

$150 Representative Junior Discount

^ Representative discount will be refunded once confirmed. Please note this applies to Juniors only.

$150 Get Going Voucher - Get in the Game Funding (Juniors Only)

For more information please go to this link: https://www.qld.gov.au/recreation/sports/funding/getinthegame/

Please upload the Get Going Voucher here:

^ If you have a copy of the voucher, please upload it here as a pdf, jpg or gif

Discounts will be confirmed after registration. If you are not eligible for one of the above discounts you've selected, you will be informed and asked to pay the remaining difference. Thank you.

Coupon Code

If you have a discount or coupon code, please enter it here. If correct, the price will adjust automatically. Please note, it is case sensitive.

Total Membership Cost: $

Please provide any other comments to add with your membership registration:

Acknowledgement of Privacy Act, Indemnity Release and the Code of Conduct
Please click here to read the terms of the membership agreement.

Please confirm the below to complete your registration:

I acknowledge and agree to the terms, code of conduct and privacy agreements for Membership with the Helensvale Cricket Club Inc.

Total Credit Card Payment: $

Total Surcharge: $

Please note, there is a 1.75% surcharge for all Visa, MasterCard and Amex payments made online.

Once you click submit payment and complete any further details. Please wait a few seconds for your payment to be saved and processed. Thank you.