Register

Required fields are marked with an asterisk (*)

* Given Name

* Family Name

* Email Address

* Username

Please enter a user name using only letters, no spaces or punctuation marks

* Password

Please create a password for yourself with at least 6 characters

Strength: Very Weak

* Gender

Male

Female

Other

* Home Address

Address Line 2 (Optional)

* Suburb

* Postcode

* State

Country

* Home Phone

Mobile Number

* Emergency Contact Name

* Emergency Contact Phone Number

* Second Emergency Contact Name

* Second Emergency Contact Phone Number

Date of Birth (DD/MM/YYYY)

You must be over the age of 18.

* Email Subscription

Yes

No

I agree to a "Email Subscription" through MailChimp so that I can receive updates from The Bush Club about its activities, meetings and any other Bush Club information. Note: The email subscription is strictly for receiving emails about The Bush Club and its activities. If you tick "No", you are responsible for checking the website regularly for the information.

* Declaration

I am over 18 years of age.

* Acknowledgement

I have read the Risk Acknowledgement form and accept its conditions.

Click here to view the Risk acknowledgement form: [Click Here]

Please click here and read the Information for Prospectives. This document provides important information for those wishing to join the club: [Click Here]

* Information for Prospectives

I have read the Information for Prospectives and understood the requirements

Bush Walking Clubs

Yes, I am an active member of another bushwalking club?

Yes, I have been a Prospective Member of The Bush Club previously?

Yes, I have been a Full Member of the Bush Club previously?

How have you heard about us?

Word of mouth

Other web sites

Internet search

Other - please specify below

Other Sources

Name of Person who introduced you to The Bush Club (Optional)

Comments

The Bush Club

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The Bush Club

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