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Lilydale RSL

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Affiliate Application Form

Homepage | Membership | Affiliate Application Form

Lilydale RSL
AFFILIATE APPLICATION FORM

Affilate Requirements Available to relatives of a person who is or was eligible to be a Service Member of the League.

Also available to members of the emergency services (police, fire brigade, CFA, ambulance and/or SES.

Applicants are required to provide documentary evidence of service history.

Please enable JavaScript in your browser to complete this form.

been SIGNATURE Method

Have you been a member of the RSL before? *

Yes
No

PREVIOUS RSL MEMBERSHIP DETAILS

State *

Sub-Brand Name *

Sub-Branch Joining

Membership Category *

Affilitate
Service

Period *

1 Year
3 Years

YOUR DETAILS

Title *

Mr
Mrs
Ms
Miss
Other

Full Name *

First

Last

Preferred Name *

Post Nominals (suffix) *

Gender *

Male
Female

Date of Birth *

ADDRESS

RESIDENTIAL ADDRESS *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Same Address

Postal address is the same as my residential address

POSTAL ADDRESS

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

CONTACT DETAILS

Mobile *

Home

Business

Email *

Preferred Contact Method

eMail
Mail
Phone

NEXT OF KIN DETAILS

Full Name *

Contact Number *

Relationship *

AFFILIATE PERSON SERVICE DETAILS

Their Name *

First

Last

Country *

Your Relationship *

Service Force *

Australian Defence Force
Allied Armed Force

Service *

Army
Navy
Air Force
Merchant Navy

Your Own Current or Past Emergency Service Work

Ambulance
Fire Brigade (CFA & FRV)
Police
SES

SIGNATURE

Signature *

Clear Signature

Checkboxes *

I declare that the information provided is true and correct, and I agree to uphold the Constitution of the League and its By-Laws

Located at the gateway to the Yarra Valley the Lilydale RSL has been in operation since 1919 and is a traditional non-pokies venue with limited operating hours with some of the best bar prices in the area.

Contact Us

52 Anderson Street, Lilydale, Vic 3140
PO Box 88, Lilydale, Vic 3140 03 9739 5680
info@lilydalersl.com.au

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