APPLICATION FOR MEMBERSHIP

TO OFFICIAL RICHMOND CHEER SQUAD

2010

 Please Print details clearly

NAME:              ---------------------------------------------------------------------------------------------------------------

 ADDRESS:       ---------------------------------------------------------------------------------------------------------------

                         ---------------------------------------------------------------------------------------------------------------

STATE:             ------------------------------------                        POSTCODE--------------------------------------

 DATE OF BIRTH            ----------/-------------/-------------

 PHONE:            H)------------------------------------------------------------------------------------------------------------

 PHONE:            W)-----------------------------------------------------------------------------------------------------------

PHONE:            M)-----------------------------------------------------------------------------------------------------------

 EMAIL              ---------------------------------------------------------------------------------------------------------------

 RFC/AFL CLUB SUPPORT MEMBERSHIP ID (COMPULSORY): ---------------------------------------------

 I would like to purchase --------* shares in the sponsorship of Trent Cotchin at $5 per share ( *Insert number required)

Signature          -----------------------------------------------------------------------------------------------------------------

# Associate members include persons 25 years and over when joining for the first time or renewing membership after a break and members of other Cheer Squads  

Membership form to be posted to