Members

date_time

id

Your Name

Your Address

Suburb/Town

Post Code

Your Email

Please Select Your Age Range

21-30

31-40

41-50

51-60

61-70

70+

Do you wish to have a monthly newsletter emailed?

Yes

No

Are you an existing member?

Yes

No

Type of membership

Single

Family

Please list the types of activities you are interested in.

Craft

Self Help

Exercise

Cooking

Men's Shed

Games

Children's Programs

Computer Classes

All of the above

Would you like to receive information regarding upcoming Courses/Activities/Events?

Yes

No

Are you interested in learniing about volunteering within this centre?

Yes

No

Do you agree to the terms and conditions of the Simpson & District Community Centre?

Yes