GOLD COAST CITY JAZZ CLUB Inc. 5 Melaleuca Drive Palm Beach QLD 4221

Website www.gccityjazzclub.com Email gccityjazzclub@gmail.com MEMBERSHIP RENEWAL/APPLICATION to 31st December 2024
SURNAME (Mr / Mrs / Ms)..………………………………………………
FIRST NAME………………………………………………………………
ADDRESS…………………………………………………………………………
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POST CODE……………………
EMAIL ADDRESS…………………………………………………………….…
PHONE NO…………………………………………………………
MOBILE PHONE NO………………………………………………………..…
MUSICIAN Yes / No Instrument………………………………………
In making application for membership of the Gold Coast City Jazz Club Inc, I agree to abide by the Constitution of the Association.
SIGNATURE…………………………………………… DATE……………


2024 Annual Subscription (Please mark your selected fee) Membership Adult $25.00 Student Youth (18 – 25) $10.00 Junior Under 18 years $ 5.00
Please return, with payment, to Gold Coast City Jazz Club Inc. 5 Melaleuca Drive Palm Beach QLD 4221 OR Direct Deposit to Heritage Bank BSB 638 070 A/c number 1051 3655