Test Member Renewal Form – Sutherland Bushwalkers

Last Name *

First Name *

Date of Birth (dd/mm/yyyy) *

Email *

Confirm Email

Residential Address *

Suburb *

Post Code *

Best Contact Telephone Number *

Mobile Telephone (if different)

Emergency Contact Name *

Used to contact in case of emergency

Emergency Contact Relationship *

Emergency Contact Phone *

Are you First Aid Qualified? Y/N

If Yes, First Aid Qualification

Postal Address if Different to Residential Address

Membership Options *

Please note. Social members cannot participate in any walking, cycling or kayaking activities. Full members are covered by Bushwalking NSW insurance.

WAIVER

Agreement to Waiver *