Membership Application

Given Names *
Surname *
Email Address *
Phone No. *
Date of Birth *
Street Address *
Suburb *
State *
Postcode *
HOW DID YOU HEAR ABOUT SCTC MEMBERSHIP?
Existing SCTC MemberSocial MediaRadio AdvertisementNewspaperOther
Are you currently licensed in connection with galloping, harness or dog racing?
YesNo
Are you otherwise connected with racing in any way?
YesNo
Have you ever been adjudged guilty of malpractice in connection with any sport?
YesNo
Have you ever been expelled from membership of any club?
YesNo
Have you ever had your membership of any club cancelled or suspended?
YesNo
Have you ever incurred liabilities in connection with horse racing and not discharged the same in full?
YesNo
Are you 18 years of age or older?
YesNo
I hereby declare that the answers given by me to all questions are true and correct. I have not withheld information that may affect the board of management decision as to my eligibility for membership and I agree to abide by the rules and regulations of the club.
YesNo
Select the membership type