Membership Form Membership Registration Form Division Seniors Name* Parent's Name* PhoneAddress Membership Number (if known): Email Address Allow photo and media release? Yes You need to be registered before the season begins: Click Here to Register You need to be registered before the season begins: Click Here to Register You need to be registered before the season begins: Click Here to Register Membership Type* Single Social Membership $50 Single Player Nomination $110 Total $ 0.00 Please forward payment via cheque or EFT Imperials Football ClubPO Box 382 ManjimupWA 6258 OR Imperials Football ClubBSB 036-126A/C # : 602220 Please remember to use your first and last name and/or your membership number as reference so we can identify your payment.Date MM slash DD slash YYYY
