Fillable Form 2: 2021/22 VRC RESTRICTED MEMBERSHIP APPLICATION (Australian National University)

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Form 2: 2021/22 VRC RESTRICTED MEMBERSHIP APPLICATION (Australian National University)

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The Form 2: 2021/22 VRC RESTRICTED MEMBERSHIP APPLICATION (Australian National University) form is 2 pages long and contains:

  • 4 signatures
  • 13 check-boxes
  • 52 other fields

Country of origin: AUSTRALIA
File type: PDF

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We the undersigned, desire to propose the applicant for membership of the Club.
PLEASE NOTE Application will be delayed if nominators have not provided full particulars.
PROPOSER’S DETAILS (must be a full financial VRC member) I have known the applicant for
years
socially and believe him/her to be a fit and proper person for membership.
PROPOSER’S NAME (in block letters)
Member No. Signature
SECONDER’S DETAILS (must be a full financial VRC member) I hereby second the nomination.
I have known the applicant for years socially and believe him/her to be a fit and proper person for membership.
SECONDER’S NAME (in block letters)
Member No. Signature
TITLE GIVEN NAMES SURNAME DECORATIONS
TO BE COMPLETED BY APPLICANT
1 Date of birth
2
Postal address
P/Code
3
Contact details Private ph Mobile
Email
4
Occupation Company
5
Names of other clubs of which you are a member
I consent to VRC contacting the clubs nominated for the purpose of verifying my membership. Yes No
6
If yes to any of the questions below, please attach full particulars.
Yes No
• Has your application for membership of any club been rejected or deferred;
• Have you ever been disciplined by a Committee of a club;
• Have you ever been convicted in any court of an offence (other than a minor traffic offence);
• Have you ever been bankrupt or insolvent or assigned your estate for the benefit of or entered into any composition with your creditors;
• Have you incurred liabilities in connection with horse racing and not discharged same in full or been declared a “defaulter in bets”?
7
Would you like to nominate an authorised contact to access, purchase products Name:
or make changes to your personal or membership details on your behalf Ph no:
/
Suburb State
Postcode
/
FOR OFFICE USE
ONLY Member No:
Signature of applicant Date
TO BE COMPLETED BY PROPOSER & SECONDER
Min 32mm
Max 36mm
* All applicants must submit a colour,
passport-size photo as part of their application.
AFFIX
PASSPORT
PHOTO
HERE*
I agree to the accompanying nomination and hereby apply for membership of the Victoria Racing Club Limited.
Declaration: By signing below, I agree that I have read, agree to and should by membership application be accepted, will be bound by Victoria Racing Club
Limited (VRC)’s Constitution, By-Laws and Membership Conditions, including those additional terms and conditions expressly referred to within the Membership
Conditions, as published and amended by VRC from time to time and available at www.vrc.net.au/terms-and-conditions. Should I not agree, I will notify VRC
within 30 days of receiving my subscription notice, and I acknowledge that VRC will then cancel my membership and refund all fees paid. I also hereby declare the
information given above is true and correct and that there is nothing to my knowledge that would prevent me from becoming a member of VRC, nor have I withheld
any information likely to affect my eligibility for membership of VRC.
2021/22 VRC RESTRICTED MEMBERSHIP APPLICATION
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Privacy Notice: VRC is collecting your personal information to facilitate your membership application and, if approved, administer your membership and its benefits.
VRC may use and disclose your personal information as set out in this statement, our Privacy Policy (www.vrc.net.au/privacy-policy) and in accordance with your privacy
preferences. If you do not provide your personal information we will not be able to process your application or, if approved, administer your member benefits. We may
disclose your personal information to other parties, including our service providers, partners and sponsors (that may be located overseas from time to time). Our Privacy
Policy contains information about how you may access and seek correction of your personal information, how to complain about a breach of your privacy, and how we
will deal with that complaint.
Victoria Racing Club Limited (ACN 119 214 078) | 448 Epsom Road Flemington VIC 3031
Phone: 1300 727 575 | Email: applications@vrc.net.au | Web: vrc.com.au
2021/22 VRC RESTRICTED MEMBERSHIP APPLICATION
PAYMENT
MASTERCARD
VISA
AMEX
DINERS
Card No Exp. Date: /
Cardholder’s name
Payment option 1: Amount $939 OR Payment option 2: Amount $576
Cardholder’s signature
OR CHEQUE
Enclosed is a cheque for $939 OR $576 payable to Victoria Racing Club Limited
Restricted membership is your gateway to Full membership. This membership category provides you with many of the same
privileges as Full membership, but with a few exclusions.
Restricted members are not able to access the Members Enclosure on Penfolds Victoria Derby Day and Lexus Melbourne
Cup Day, however can still enjoy these days with access to the Members Reserved Car Parks, The Birdcage and all general
admission areas.
APPLICATION PROCESS
Once your application form has been received it will be presented before the Board of Directors of the Victoria Racing Club
for approval. Upon approval of your application, we will provide you with a confirmation and process your payment according to
your chosen option outlined below.
Payment option 1 allows you to pay the joining fee of $726 and Restricted membership fee $213 upfront in year one.
Payment option 2 allows you to pay a combined fee of $576 for the first year of membership. This combined fee includes
the Restricted membership fee and part payment of the joining fee. The remainder of your joining fee will be due on the earlier
of when you: (i) are elevated to Full Membership; or (ii) cease to be a member of Victoria Racing Club.
Automatic Renewal of your Membership
VRC offers automatic renewal of membership, which means VRC will automatically renew your membership in July each year
and process the applicable payment, giving you two weeks’ notice beforehand.
By selecting this box, you consent to VRC automatically renewing your membership, including annual car park and guest
cards (if purchased).
By agreeing to automatic renewal of membership, you agree to VRC:
· Automatically renewing your membership annually (including annual car park and guest cards if purchased) during the
month of July each calendar year (exact date to be confirmed by VRC at least two weeks prior to the date);
· Taking payment of the relevant membership fee from you; and
· Securely storing your credit card details, in accordance with the Membership Conditions.
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Form 2: 202122 VRC RESTRICTED MEMBERSHIP APPLICATION (Australian National University)

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Completed 9 May 2022

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