2010 Club Membership Application
Membership valid from 1 January 2010 – 31 December 2010
Application DETAILS
Date of Birth
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Title
Membership Number
Firearms Licence Number
First Name
Surname
Address
Phone
Home
Work
State
Postcode
Mobile
Email
@
*Explanations for each Membership Category on back of FORM
Membership Categories

ACTA
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Cost
CPCTC ONLY
Cost
Full Member
$175.00
Clay Target Only
$80.00
Partner Member
$125.00
Clay Target Family Rate
$70.00
Long Service Member
$125.00
Clay Target Junior Rate
$60.00
Intermediate Member (18-21yrs)
$125.00
Junior Member (12-18yrs)
$100.00
Clay Target & Hunting
$95.00
Veteran Member (65 yrs+)
$125.00
Clay Target & Hunting Family Rate
$75.00
Club Only Member (incl magazine)
$133.00
Clay Target & Hunting Junior Rate
$75.00
New Start Membership
$108.00
Hunting Only
$70.00
New ACTA Members joining fee
$12.50
Hunting Family Rate
$60.00
Optional Hunting Club Member
$50.00
Hunting Junior Rate
$50.00
Social Membership
$60.00
Total Amount Due
$
Total Amount Due
$
Payment Information
My cheque or money order made payable to CECIL PARK CLAY TARGET CLUB
Charge $..........................my credit card :
VISA
MasterCard
Credit Card Number
Expiry Date
Signature
PRINT Cardholder Name
Post to : CPCTC
PO Box 260
Horsley Park, NSW
2175
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I have read and agree to abide by the #Terms & Conditions set out by the ACTA & CPCTC constitutions to participate as a
considerate member of society while frequenting the CPCTC grounds.
Office Use Only
Receipt Number:
Entered ACTA form:
Entered CPCTC Database:
Date RECEIVED:
TO BE FULLY COMPLETED BY STAFF
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Staff Initial
Viewed Licence
Swipe card issued
Date PAID:
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