MUKC Membership Form

Email Address (required)

Given Name (required)

Surname (required)

Date of Birth (required)

Address (required)

Contact Number (required)

Gender (For Competitions) (required)
FemaleMale

Citizenship Status (required)
Australian CitizenPermanent ResidentOther

Occupation

AKR ID If Known

Current Grade (required)
Ungraded6th Kyu5th Kyu4th Kyu3rd Kyu2nd Kyu1st Kyu1st Dan2nd Dan3rd Dan4th Dan5tth Dan6th Dan

Last Grading Date

Last Grading Location

Are you a University Student? (required)
YesNo

Field Of Study

Existing Medical Conditions

Emergency Contact Name (required)

Emergency Contact Phone Number (required)

Emergency Contact Relationship (required)

Murdoch Membership Fee To Pay/Paid (required)
Standard Full Year $190Standard Half Year $100Student Full Year $150Student Half Year $80No Club Fee Paid

WAKR Membership Fee To Pay/Paid (required)
Senior Full Year $100Senior Half Year $50Junior Full Year $50Junior Half Year $40Paid To Other ClubPaid Directly To WAKR

Amount Paid To Club (required)

Payment Method (required)
Paid In PersonOnline Transfer

Payment Reference/ Paid To (required)

Payment Date