Name:..........................................................

Address:.......................................................

..................................Postal Code:.................

Date of birth..................................................

Tel. (H):........................(B):..........................

Please send me the following 1996 Essendon Football Club Membership ticket/s

Categories         No. required     Price         Value

Adult              ............     @$86.00     ..........

Concession 22      ............     @$68.00     ..........

Concession 11      ............     @$46.00     ..........

AFL Squadron       ............     @$16.50     ..........

Family (no of children)  ............    @$166.00     ..........

Country            ............     @$51.00     ..........

The Mosquito Fleet ............     @$40.00     ..........

Campaign T-shirt   ............     @$25.00     ..........
  Please indicate preferred size: ...large  ...extra large
If purchasing a concession ticket please include a copy of the
appropriate identification with this application form. 

Please allocate the following MCG reserved seat/s
Great Southern Stand
Level 1 (undercover) ........ seats @ $65.00 per seat .........

Level 1 (open)       ........ seats @ $45.00 per seat .........

Level 2A (open)      ........ seats @ $60.00 per seat .........

Family Package (Level 1 open)     @ $135.00 (4 seats) .........
2 adults, 2 children (Squadron tickets)

                                 TOTAL PAYABLE ..........

(Please make cheques payable to Essendon Football Club)
		Send to:	The Membership Manager
				Essendon Football Club
				PO Box 17
				Essendon VIC
				Australia 3040
		Phone 9375 3211  Fax 9370 6804


Credit Card Payment Authorisation

Please debit my:  Bankcard ..    MasterCard ..    Visa ..

Card No: .. .. .. ..  .. .. .. ..  .. .. .. ..  .. .. .. ..

Expiry Date:  .../...

Card Holder's Name: ................................. (please print)

Signature: ..................................... Date: .............