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

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

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

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

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

MCC Member (please specify)  Yes / No  MCC Number .............

Please indicate the package of your choice below:

.... Package A	OR	.... Package B
	Please indicate preferred size: ...large  ...extra large
	(Package B only)

If your selected Package A please complete the following declaration.

I declare that I am over the age of 18 years amd I agree to be bound
by the rules of the Essendon Football & Community Sporting Club, a
copy of which can be supplied on request.

Signed................................... Date .../.../.....

Nominated by (please print) ................................

Membership No. ......................

Seconded by (please print) ................................

Membership No. ......................

If you do not know any existing social club members who could nominate
or second this application, please leave blank and we shall organise this
on your behalf.

Payment Details

... Please accept my cheque for $46.00 payable to the Essendon Football Club
OR

... Please debit $46.00 from my   .. Bankcard   ..  MasterCard   ..  Visa

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

Expiry Date:  .../...

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

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

		Send to:	The Membership Manager
				Essendon Football Club
				PO Box 17
				Essendon VIC
				Australia 3040
		Phone 9375 3211  Fax 9370 6804