All it costs is $35 per year......so Join now, it’s easy!

Date .....  ./.......   /........

DOB (optional)  ......./......./.......

Full Name:..............................................……………………………………..………....

Partner/spouse (optional)………………………………………………………………….

Address:.................................................……………..……………………………………………………………….

……………………………………………………………………………State  ………………Post Code  …………..

Please PRINT clearly

Email address:.........................……………….......……………………………………………………….........……..

Phone number……….………..………..……………….

Alternative phone(s).    ……………………………………….

FOR USE IF PAYING BY CREDIT ONLY

I would like one year’s membership to the Coral Plantations Reef Club.

Details of Credit Card to be Debited (all details must be supplied) -$35.00

Credit card type

(Please CIRCLE)

Visa,… MasterCard,    Bankcard

Card No:………………………………………………………..  Signature……………………………………..

Expiry Date  ………/……….   Card Holder’s Name:………………………….…………………………..

Security number………………………… (the last 3 numbers/digits on signature strip on rear of card)

Please nominate a Username and Password

This is for our future ” Members-only” access section and Free online Photo Gallery login on our website- coming soon

Please PRINT clearly

User name …………………………

Password……………………..……….

Phone;   07 5521 0500

Fax         07 5521 0533

Email     shop@coralplantations.com

Post        6/7 Villiers Drive Currumbin Waters QLD 4223