Personal DetailsSelect *MrMrsMissMsDrFirst Name *Last Name *Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweD.O.B *Contact Number *Email *Private Health Fund Ambulance Cover YesNoEmergency Contact *Relationship Contact Number *ADG Member Number Membership Options Yearly- Includes into League Day comps and Random Format Days (held monthly) League Day insurance, Invitation to club events, Option to be on the committee, Member number, Eligibility to compete in Bag Tag challengesAdult $80Junior $ 35Single Event Entry into single League Day event, League day insurance, Loan Discs if required, (Points from single league day event will only count towards championship tally if a full membership is purchased.)Adult $10Junior $5 NOTE: Maximum of 3 single events may be used by an individual in a season, after which a full membership must be purchased. This enables you to be eligible for the MGDG ‘LEAGUE CHAMPION’ (4 of your best scores throughout the season added together) and eligible to compete in the MGDG end of season championship.I have read and understood the MGDG Code Of Conduct *Yes I AcceptConsent for media/photography/videography I grant permission for Mount Gambier Disc Golf to use and publish details from time to time including my/our names, event details and outcomes, photographs/images, audio or video footage of myself or my child/ren for promotional purposes on the club’s social media and online channels (websites, Facebook, Twitter etc.), in newsletters and occasional main media such as related websites or newspapers. I understand that any details, images, video or audio taken may be seen in a public environment including within and outside South Australia. I authorise the use of these images without compensation to me. All prints, digital reproductions shall be the property of Mount Gambier Disc Golf.Yes I give consentI agree to inform MGDG of any changes to above personal details Yes I agreePayment Membership payments need to be made in full prior to the start of the monthly league day or within 14 days which ever arrives first. Cash payments can be made on the league day to MGDG Club or Bank Transfer payments can be made to. Mount Gambier Disc Golf. BSB: 633 000 Account number: 167 074 111. Use Name as referenceSection Fieldset Verification10+7= *Example: 12This box is for spam protection - please leave it blank: MGDG Code of Conduct .Pdf
