Membership Application / Renewal

Membership Form	Please select the type of membership: Select an option. Ordinary Single Member $40.- Family Member $60.- Associate Single Member $40.- Associate Family Member $60.- RENEWING Ordinary Single Member $40.- RENEWING Family Member $60.- RENEWING Associate Single Member $40.- RENEWING Associate Family Member $60.-	How paying for membership: Select an option. I will use Card/Paypal here. I will post a cheque I will do a direct deposit to Heimdal I will pay next time in the club
Names and Birthday	Name:(REQUIRED)	Partners Name:
	Your date of birth:(REQUIRED)	Partners date of birth:
	1st Child Name:	Child 1 DOB:
	2nd Child Name:	Child 2 DOB:
	3rd Child Name:	Child 3 DOB:
	4th Child Name:	Child 4 DOB:
Contact Details	Home phone:
	Mobile phone:	Work phone:
	Street Address:(REQUIRED)	City or Town:(REQUIRED)
	State:(REQUIRED)	Post code:(REQUIRED)
	Do you speak or read Danish: Select an option. Spoken Danish only Read and Speak Danish Read and Speak some Danish Read some Danish Speak some Danish	E-mail Address:(REQUIRED)
	Write us a message:

Submit Application	To reduce spam from this form we require you to read the characters in the image then type them in the box below, please be aware and retype the lower/upper case as used.
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