hornsby pcyc 2012 performing arts information enrollment pack

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Act Sing Dance Music Perform Enrollment Information Hornsby Ku-ring-gai PCYC Performing Arts Centre Cnr Waitara Ave & Edgeworth David Ave WAITARA NSW Telephone: 9477 2310 Email: [email protected] Web: www.pcycnsw.org/hornsby Pack

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Full information of the Hornsby Ku-ring-gai PCYC Performing Arts programs fopr 2012 Term 1 & 2

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Page 1: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Act

Sing

Dance

Music

Perform

Enrollment

Information

Hornsby Ku-ring-gai PCYC Performing Arts Centre Cnr Waitara Ave & Edgeworth David Ave WAITARA NSW Telephone: 9477 2310 Email: [email protected] Web: www.pcycnsw.org/hornsby

Pack

Page 2: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Act

Sing

Dance

Music

Perform

Enrollment

Information

Pack

Hornsby Ku-ring-gai PCYC Performing Arts Centre Cnr Waitara Ave & Edgeworth David Ave WAITARA NSW Telephone: 9477 2310 Email: [email protected] Web: www.pcycnsw.org/hornsby

As we enter our 3rd year of providing performing arts programs for

our youth and adults we are very excited about the programs we have

on offer for the fist half of 2012.

Four new programs have been added for terms 1 & 2 being;

Dance Movement Sound, African Drumming, Guitar Circle and Rock

Uke.

All our existing 2011 programs will continue that were so successful

last year and have grown not only in numbers but in reputation.

We are often asked why our fees are so inexpensive. The answer is simple. When we, the Hornsby

Ku-ring-gai PCYC, first planned to open this performing arts centre we had a few criteria that

would be in place :

A wide variety of performing arts programs for all ages

A growing community facility for the high quality performing arts performances and event

A facility that will nurture our local talent

A faculty of high quality tutors

A Safe environment for children that is drug, alcohol and bullying free

AND… above all… programs that are open and affordable to all!

I hope to see you either as a student or an audience member in 2012. It’s going to ne a great year!

Greg Bepper

Artistic Director

Hornsby Ku-ring-gai PCYC Perfoming Arts Centre

Page 3: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Act

Sing

Dance

Perform

Monday

5.00 - 6:30pm

Ages 8 - 15

Acting - Singing - Dancing: All three make up the musical theatre performer.

This is what MTK is all about. Learning the three disciplines of this theatre genre BUT with a

whole lot of fun during the journey.

Every week you will be trained in all three while at the same time rehearing the current kids

musical in preparation for the performance season.

Current Production: ‘Kids Town’Current Production: ‘Kids Town’Current Production: ‘Kids Town’Current Production: ‘Kids Town’

After a successful ‘Showcase Performance’ of this original musical especially written for MTK in

December 2011. We are now ready to rehearse and perform the full production during Terms 1 &

2. Three Performances will be produced in June 2012. 5 new characters have been added for the

completed production

Dates Term 1: 6 February - 26 March 2012 (8 weeks) Term 2: 23 April - 25 June 2012 (9 weeks) Performance: ‘Kids Town’ Friday 22 June, Sat 23 June & Sat 30 June 2012 - 7pm

Fees Term 1: $160 Term 2: $180 Terms 1 & 2: $340 Membership/Renewal: $ 11 (If applicable)

Tutors:

Marcelo Toro - Dancing & Singing (Kid’s Town Choreographer)

Greg Bepper - Acting & Theatre Craft (Kid’s Town Director)

Maximum: 25 students/performers

Photo:

Performing

Disney’s Aladdin

- March 2011

Page 4: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Sing

Dance

Monday

6.45 - 7:45pm

Ages 8 - 16

This is a brand new addition to our 2012 programs. A different approach to dance & voice co-

ordination than you have ever experienced before.

Each term you develop your skills in dance & movement through fun but professional exercises

in body awareness, movement, dance interpretation, stamina, dance improvisation, partners. .

This will be in harmony with voice techniques as breathing, pitch, harmonies, projection, song

interpretation.

Learn different styles of dance and movement techniques ranging from contemporary to Latin

to belly dancing to the far east. Experience improvised movement and how to create your own

chorography. Add this to attuning your voice to unique sounds of the crystal bowls and other

exotic instruments. Experience dance and sound as an ensemble creating free-style and

choreographed Dance, Movement and Sound routines’

Dates Term 1: 6 February - 26 March 2012 (8 weeks) Term 2: 23 April - 4 June 2012 (7 weeks)

Fees Term 1: $120 Term 2: $105 Terms 1 & 2: $225 Membership/Renewal: $ 11 (If applicable)

Tutor

Marcla Toro: You will love Marcla’s unique approach to Dance,

Movement and your Voice even if you have never attended a

dance or voice class before

Maximum: 30 students

Photo:

Marcela & students

Page 5: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Act Monday

8.00 - 10:00pm

Ages 16+

The art of Acting is no only for the stage but teaches many skills for everyday life.

This short course has been developed as an introduction to acting for newbies but is certainly

beneficial also to the more experienced that wish to develop or revisit their theatrical skills.

Over the six weeks you will experience 6 different aspects of the art which include:

improvisation, character creating & script analysis , props & your body, theatrical mime,

relaxation, concentration & observation and theatre craft.

The opportunity may also arise to be invited to join the Hornsby Ku-ring-gai PCYC Theatre Co

for their next production season in November

Dates Term 1: 20 February - 26 March 2012 (6 weeks) Term 2: 7 May - 4 June 2012 (6 weeks)

Fees Term 1: $120 Term 2: $120 Membership/Renewal: $ 11 -18 (If applicable) $ 24 18+

Tutor

Greg Bepper: For almost four decades Greg has been in the

industry as an actor, director, writer, prodcer, tutor and film

maker

Maximum: 15 students

Photo: Improvisation

Page 6: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Music

Perform

Tuesday

5.00 - 6:00pm

Ages 9 - 17

‘.. the rhythm of life is a powerful beat”

And what an irresistible rhythm are those of Africa! You grow to love as you learn all the parts

of an African rhythm and play a variety of African drums.

Enjoy the experience the of playing the most basic but powerful ancient instrument ‘the

djembe’.

Experience the drumming traditions of Mali, Guinea, Senegal, and Ivory Coast. Students will

learn rhythmic patterns, hand coordination, and the musical tones of the djembe

Drums are supplied or you can Bring Your Own.

Dates Term 1: 7 February - 27 March 2012 (8 weeks) Term 2: 24 April - 12 June 2012 (8 weeks)

Fees Term 1: $120 Term 2: $120 Terms 1 & 2: $240 Membership/Renewal: $ 11 (If applicable)

Tutor

Kate Robinson: Kate has many years experience in teaching the

art and culture of African drumming. She is also a performer in

her own right.

Maximum: 30 students

Photo:

African Drumming in

Hornsby Park

Page 7: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Tutor

Candice Southon: A patient and qualified

tutor for many years and a performing singer/

songwriter

Maximum: 20 students

Music

Tuesday

5.30 - 6:30pm

Ages 8 - 17

New for 2012. Learn to play the guitar in the relaxed and non pressure atmosphere of a guitar

circle.

You and your fellow students will take this musical journey together every week while learning

the fundamentals of guitar playing: basic chords, strumming, picking, guitar licks, reading chord

charts.

All this while learning popular and well known tunes. Each week you will gain the confidence to

explore new tunes in your own time.

Absolutely no prior musical experience needed. No note reading required. All printed materials

provided. Own guitar necessary, this does not have to be a top of the range instrument. An

inexpensive beginners guitar is perfect for this guitar circle. We can also arrance a discount

through our sponsor Pro Guitar & Sound Hornsby

Dates Term 1: 7 February - 27 March 2012 (8 weeks) Term 2: 24 April - 12 June 2012 (8 weeks)

Fees Term 1: $ 120 Term 2: $ 120 Terms 1 & 2: $ 240 Membership/Renewal: $ 11 (If applicable)

Photo: Candice Southon

Page 8: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Music

Perform

Wednesday

5.30 - 6:30pm

Ages 9 - 17

New for 2012. Love your rock and would love to be in a band.. Well here is your chance!

The ukulele resurgence in 2011 has been phenomenal! Here is now chance to learn a musical

instrument and play your favourite rock tunes.

You will quickly be able to hear the results of your efforts as you learn a variety of chords and

strums. No previous musical training is needed just bring along your own ukulele or we can

arrange or we can provide a Uke to start you off and/or then a discount through our sponsor

Pro Guitar & Sound in Hornsby.

Once the group has mastered their rock tunes you will perform at our various showcases

through the year.

Dates Term 1: 8 February - 28 March 2012 (8 weeks) Term 2: 2 May - 13 June 2012 (8 weeks)

Fees Term 1: $120 Term 2: $120 Terms 1 & 2: $240 Membership/Renewal: $ 11 (If applicable)

Tutor

To be announced

Maximum: 25 students

Page 9: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Music

Perform

Wednesday

7.30 - 9:30pm

Ages 14+

Now in its 3rd year We provide an environment where musicians from the local community and

beyond can come together to perform music from many different genres - pop tunes to jazz to

rock to musicals to concert pieces.

The grade level of band music we perform is from Medium to Advanced. (A and B grade), Our

membership consists of more advanced students from Year 11 and 12 through to adults. Come to a

rehearsal and get started. Own instrument and folding music stand essential

Jazz Band

Commencing in 2012 we will be forming a jazz band to perform at our showcase events and out

in the community

Dates Term 1: 8 February - 4 April 2012 (9 weeks) Term 2: 2 May - 27 June 2012 (9 weeks)

Fees Term 1: $108 Term 2: $108 Terms 1 & 2: $216 Membership/Renewal: $ 11 -18 (If applicable) $ 24 18+

Conductor/Bandleader

2012 Conductor/Bandleader yet to be

announced

Maximum: Unlimited Musicians

Photo: Rehearsal

Page 10: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Dance

Perform

Thursday

4.00 - 7:00pm

Ages 3 - 17

Bollywood dancing is a great way to have fun, get fit, learn a dance, and make new

friends. Suitable for everyone. Bollywood dance is fusion of various Indian Folk and classical

dance styles. The dance is generally seen on Bollywood or Hindi films and choreographed by a

Bollywood Choreographer.

Classes:

Pink Flamingos - Ages 3 - 5 years - 4 pm to 5pm

Dancing Divas - Ages 6 - 9years - 5pm to 6pm

Bollywood Blitz - Ages 10 - 17 years - 6pm to 7pm

For performances all costumes and props provided like Saris, Lahengas (colourful long skirts)

and you work with great popular Bollywood music and colorful props like balloons and streamers.

Dates Term 1: 6 February - 26 March 2012 (8 weeks) Term 2: 23 April - 25 June 2012 (10 weeks)

Fees Term 1: $160 Term 2: $200 Terms 1 & 2: $360 Membership/Renewal: $ 11 (If applicable)

Tutor

Dola; a highly trained Bollywood tutor and performer

Maximum: 25 students per class

Photo: Performance

Page 11: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Sing

Music

Perform

Friday

4.30 - 6:45pm

Ages 8 - 15

Want to sing...but don't want to go solo? The Hornsby PCYC Youth Choir is for you! This is a

non audition choir for all young people.

Now in it’s 3rd year the repertoire is eclectic, covering anything from early music and folk to

classical to jazz and contemporary. Choristers get to sing unison as well as harmony. Includes

vocal health and musicianship, as well as what it means to be part of a choir team.

A typical rehearsal includes vocal exercises, physical movement, good humour and serious

singing. The Voice for Life vocal program is used in the sessions.

Our choristers have the opportunity to perform, both informally and formally, for a variety of

audiences including; Recitals at the Performing Arts Centre, eisteddfods, festivals and

competitions and collaborate with other choirs and eventually tour.

Dates Term 1: 3 February - 5 April 2012 (9 weeks) Term 2: 27 April - 29 June 2012 (10 weeks) Performance: 19 May 2012 7pm

Fees Term 1: $108 Term 2: $120 Terms 1 & 2: $225 Membership/Renewal: $ 11 (If applicable)

Tutor

Donrita Reefman: her knowledge teaching techniques of music

and chorale requirements are second to none. Produces amazing

results in a very brief time and with students of little experience.

Maximum: Unlimited Choristers

Photo:

Choir concert recital

Page 12: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Act Saturday

9.00 - 10:30am

Ages 8 - 16

ImproMania was one of the first programs we started back in February 2010 and it’s still going

strong!.

A series of weekly acting classes that have been designed not only for budding young actors &

actresses to learn the basics of the art of acting but are perfect for any child's confidence

building, developing social skills, tapping into imaginations, thinking on your feet, meeting &

interacting with new peers and having a whole-lot-a-fun!

Each week the participants are free to let their imaginations run wild and expand simple

situations into their hearts desire. This is through many and varied forms of theatrical

exercises , games and observations.

New participants can join at anytime during the term as every week the adventure is new!

Dates Term 1: 11 February - 31 March 2012 (8 weeks) Term 2: 28 April - 16 June 2012 (8 weeks)

Fees Term 1: $120 Term 2: $120 Terms 1 & 2: $240 Membership/Renewal: $ 11 (If applicable)

Tutor

Greg Bepper: Artistic Director of the PCYC Theatre Co &

Teenage Theatre Co.

Maximum: 35 Students

Photo: Improvisation

Page 13: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Act

Perform

Monday

5.00 - 6:30pm

Ages 8 - 15

Now in it’s 3rd season, the Teenage Theatre Co has revived ‘Kid’s Matinee Theatre’ for two

performance seasons a year!

This is a real theatre Co for teenagers. Members are trained in all aspects of theatre including

acting. writing, directing, lighting & sound design, props, costumes, theatre management and

theatre craft.

March 2012 Kid’s Matinee Theatre will be: ‘Apprentice 5 (The Tailor’s Torment)’ & ‘Blood Sisters’

These plays were devise and rehearsed in terms 3 & 4 last year.

June 2012 Kid’s Matinee Theatre will be part 3 of ‘Apprentice 5 ’ and a new play. Both will be

devised, rehearsed and cast in Terms 1 & 2.

Dates Term 1: 11 February - 31 March 2012 (8 weeks) Term 2: 28 April - 16 June 2012 (8 weeks) Performance: ‘ 16, 22, 30 June, 2012 2pm

Fees Term 1: $160 Term 2: $160 Terms 1 & 2: $320 Membership/Renewal: $ 11 (If applicable)

Tutor

Greg Bepper: Artistic Director of the PCYC

Theatre Co & Teenage Theatre Co.

Maximum: 20 Students/Preformers

Photo: Cast of

‘Apprentice's 5’ &

‘Spirit of Madness’

Page 14: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

E

Act

Sing

Dance

Music

Perform

Enrollment

Information

Pack

Hornsby Ku-ring-gai PCYC Performing Arts Centre Cnr Waitara Ave & Edgeworth David Ave WAITARA NSW Telephone: 9477 2310 Email: [email protected] Web: www.pcycnsw.org/hornsby

Enrollment Form The one enrolment form is all that is required for one or multiple enrolments. Simply tick the box(s) of the program(s) you wish to enroll and the term(s) Add up the total of the fee(s) write it in the space provided. Membership/renewal: If you have never been a member of the PCYC or if you have previously before 2009 you are required to fill in the PCYC membership form enclosed in this pack and include the membership fee applicable. If you were a member from 2009 you are required to fill in the PCYC renewal form enclosed in this pack and include the membership fee applicable. If you are a current 2012 PCYC member no membership/renewal form or membership fee is required. All fees and forms are required 1 week prior to commencement date

Program Cancellations and Fees The Hornsby Ku-ring-gai PCYC reserves the right to cancel any program before it commences if a minium number of students is not achieved. Full refund will be given in this event. No fee refund of fee is given after the first week or for any week(s) of non-attendance by the student. A credit for that week(s) fee will be given for any class that has been cancelled in any week(s)

Photos/Video Please note that the following clause is in the authorization section of the PCYC membership form that is signed either by the student over 18 years or a parent of a student under 18 years. There are no exceptions to this clause “I authorise PCYC to use my, or my child or ward’s, photographic image and/or voice and/or words (all known as ‘digital resource’) for promotional purposes. I assign any and all rights, title and interest in the digital resource to which I or my child or my ward may be entitled in law, to PCYC, and agree to make no claim for compensation for the use of the digital resource.

All information is correct at time of publication but may change during the course of it’s relevance.

Page 15: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

Enrolment Form February - June 2012

Program Enrolment Please tick appropriate boxes

MTK Term 1 2 1 & 2

Dance M’ment Sound Term 1 2 1 & 2

Art of Acting Term 1 2

African Drumming Term 1 2 1 & 2

Guitar Circle Term 1 2 1 & 2

Rock Uke Term 1 2 1 & 2

Little Bollywood Term 1 2 1 & 2

Youth Choir Term 1 2 1 & 2

ImproMania Term 1 2 1 & 2

Teen Theatre Co Term 1 2 1 & 2

Last Name: First Name Telephone: Mobile Email:

Address: Suburb: Postcode:

Previous Experience:

Payment: PLEASE PRINT CLEARLY Cash Cheque Credit Card Program Fee(s): $ PCYC Membership/renewal: $ [Under18]: $11 - [18+]: $24 (If applicable)

Total Payment: $ Please debit my credit card Visa Mastercard Name on card: Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiry Date: / Signature:

Office Use Only Enroll/Payment Date:` / /2012 Membership No.

Mail or in-person with payment to: Hornsby PCYC, 94 George St Hornsby NSW 2077. Cheque payable to: Hornsby PCYC No refund if cancellation within 7 days of commencement date. No Refund for days not attended.

Page 16: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

NAME OF LOCAL CLUB YOU ARE JOINING MEMBER NUMBER

STAFF USE ONLY

BEFORE APPLYING FOR CLUB MEMBERSHIP, PLEASE READALL THE INFORMATION IN THE ‘MEMBERSHIP INFO’ BROCHURE AND THIS FORMPRINT NEATLY USING ‘ALL CAPITAL’ LETTERS

MEMBER DETAILSFirst name Middle name

Family name ( your last name)

Date of birth

Street address

Suburb State Postcode

Telephone: Home Mobile Email address

TICK ONE CIRCLE ONLY ll Female ll Male

Are you of Aboriginal or Torres Strait Islander descent? ll No ll Yes Language

Do you use a language/s other than English at home? ll No ll Yes

INTERESTSWhat new activities would you like to see at your Club?

EMERGENCY INFORMATIONPARENT / GUARDIAN / NEXT OF KIN If required, PCYC staff can contact the following:

First name Family name Relationship

Telephone: Home Business Mobile

First name Family name Relationship

Telephone: Home Business Mobile

DO YOU HAVE PRIVATE HEALTH COVER? ll No ll Yes

Company name Member number

EXISTING ILLNESSES AND INJURIES

Describe any illness, injury or health issue you have, or have recently experienced:

CLUB MEMBERSHIP FORM

POLICE & COMMUNITY YOUTH CLUBS NSW LTD ABN 89 401152 271 STATE OFFICE PO BOX 595, MT DRUITT NSW 2770 TELEPHONE (02) 96259111 CONTINUES OVER

Page 17: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

CLUB MEMBER AGREEMENTCONDUCT• I have read and understand the Code of Conduct in this PCYC Club Membership Form (see over/below) and acknowledge that misconduct may lead

to suspension or cancellation of membership in, and access to, a PCYC Club.

PRIVACY• I have read and understand the PCYC statement on Privacy in this Club Membership form (see over/below).

AUTHORISATION• I authorise PCYC to obtain all necessary medical treatment which may be required by me (or my child or ward) whilst in the care, control or custody

of PCYC, including any anaesthetic or surgical attention, which may be prescribed by an appropriately qualified medical practitioner. I acknowledgethat the costs of any such treatment, including ambulance fees, will be my responsibility.

• I authorise PCYC to exercise all reasonable control, necessary in the circumstances over me (or my child or ward) or over my (or my child’s or ward’s)behaviour whilst in the care, control or custody of PCYC.

• I authorise PCYC to undertake Police Checks on me as part of its membership acceptance and review processes. I acknowledge that initial andcontinuing membership and volunteering are subject to any decision by PCYC, at its absolute discretion, based on such Police Checks andrecommendations.

• I authorise PCYC to use my, or my child or ward’s, photographic image and/or voice and/or words (all known as ‘digital resource’) for promotionalpurposes. I assign any and all rights, title and interest in the digital resource to which I or my child or my ward may be entitled in law, to PCYC,and agree to make no claim for compensation for the use of the digital resource.

• I am fully aware of the range of activities run by PCYC and consent to my or my child or ward’s participation in any activities run by PCYC, or its agents.• I do not wish to receive any information or be contacted by PCYC about its activities. ll (please tick if applicable)

PARTICIPATION• I understand that participation in PCYC activities involves the risk of injury and/or loss and damage to my property and that I participate in PCYC

activities at my own risk.• Police & Community Youth Clubs NSW Ltd, its staff, management, volunteers or agents are not liable for any personal injury, loss or damage of

property or expenses, including medical expenses, which I or my child or ward may suffer at the Club and/or as a result of a PCYC activity.• I acknowledge that I have provided medical information only for emergency purposes in this form, and that PCYC is not liable for failing to use this

information in any circumstances.

PAYMENT OF MEMBERSHIP FEE AND DONATIONSANNUAL MEMBERSHIP FEE ll Junior (17 years and under) and Concession $Note: Check with your Club for membership fee details ll Senior (over 18 years) $

DONATION TO SUPPORT PCYC’S WORK (not compulsory) ll $25.00 ll $50.00 ll $100.00 or ll $Note: All donations $2.00 and over are tax deductible

MY PAYMENT IS BY (please tick one only) ll Cash ll Cheque (payable to ‘PCYC NSW’) ll Credit Card

PLEASE CHECK IF YOUR CLUB HAS CREDIT CARD FACILITIES

If by Credit Card, please tick card name ll Visa llMaster Card ll Amex ll Bankcard

Total amount authorised Card Number Expiry Date

Name of Cardholder ( name on card) Signature of Cardholder Date

All credit card details collected in this form will be kept secure by PCYC at all times and only used for the purposes identified in this form, unlessauthorised by you, and will only be kept for as long as necessary. Membership is subject to annual renewal at PCYC’s discretion.Membership expires on 31 December each year. Members must pay an annual membership fee for each calendar year of membership.The amount of the annual membership fee may change from time to time.

ACCEPTANCE AND SIGNATUREAll the information provided in this form by me is accurate and true. I have read and accept those sections of this form relating to Conduct, Privacy,Authorisation and Participation. I acknowledge and accept that PCYC’s decision to accept or not accept my application is in its discretion and is final.You will be required to provide photo-ID when submitting this form.

Name of Applicant Signature of Applicant Date

IF THE APPLICANT IS UNDER 18 YEARS OF AGE, PARENT OR GUARDIAN SHOULD ALSO SIGNName of Parent / Guardian Signature of Parent /Guardian Date

OFFICE USE ONLY

Witness Name (PCYC Staff Member) Signature of Witness Date

Form of ID provided llDriver License ll Passport llOther (specify)

PCYC RECEIPT NUMBER RECEIPT DATE

$

Page 18: Hornsby PCYC 2012 Performing Arts Information Enrollment Pack

MEMBER DETAILSFirst name Family name ( your last name) Date of Birth

PLEASE ADVISE ONLY IF ANY PERSONAL INFORMATION HAS CHANGEDAddress Suburb State Postcode

Telephone: Home Mobile Email

EMERGENCY CONTACT First Name Family Name Relationship

Telephone: Home Mobile

Please indicate any changes to personal, health or health insurance details

CLUB MEMBERSHIP RENEWAL

PAYMENT OF MEMBERSHIP FEEANNUAL MEMBERSHIP FEE ll Junior (17 years and under) and Concession $

Note: Check with your Club for membership fee details ll Senior (over 18 years) $

MY PAYMENT IS BY (Tick one only. DO NOT POST CASH) ll Cash ll Cheque (payable to ‘PCYC NSW’) ll Credit Card

CHECK IF YOUR CLUB HAS CREDIT CARD FACILITIES ll Visa ll Master Card ll Amex ll Bankcard

Total amount authorised Card Number Expiry Date

Name of Cardholder (name on card) Signature of Cardholder Date

MEMBERSHIP IS SUBJECT TO PCYC’S DISCRETION. MEMBERSHIP EXPIRES ON 31 DECEMBER EACH YEAR. MEMBERS MUST PAY AN ANNUAL MEMBERSHIP FEE FOR EACH CALENDAR YEAR OF MEMBERSHIP. THE AMOUNT OF THE ANNUAL MEMBERSHIP FEE MAY CHANGE FROM TIME TO TIME.

ACCEPTANCE AND SIGNATUREYes, I confirm acceptance of the Conduct, Privacy, Authorisation and Participation provision of my original membership. You will be required to provide photo-ID when submitting this form.

NAME OF APPLICANT Signature of Applicant Date

PARENT OR GUARDIAN If applicant is under 18 years Signature of Parent /Guardian Date

OFFICE USE ONLY

NAME OF WITNESS PCYC Staff Member Signature of Witness Date

FORM OF ID PROVIDED ll Driver Licence ll Passport ll Other (specify) CLUB NAME MEMBER NUMBER RECEIPT NUMBER RECEIPT DATE

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1. PRINT NEATLY USING ‘ALL CAPITAL LETTERS’2. HAND PAYMENT AND FORM TO YOUR CLUB OFFICE,

OR POST WITH CREDIT CARD DETAILS OR CHEQUE DO NOT POST IF PAYING BY CASH

YES, I WOULD LIKE TO RENEW MY PCYC MEMBERSHIPCLUB MEMBERSHIP AND VOLUNTEERING ARE SUBJECT TO POSSIBLE POLICE CHECKS AND ANY DECISION BY PCYC, AT ITS ABSOLUTE DISCRETION, BASED ON THOSE CHECKS AND RECOMMENDATIONS.