The Alcott
Join The Alcott
Type of Form
Member Number
Personal Details
Title
Mr
Mrs
Miss
Ms
First Name
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Last Name
*
Date of Birth
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Phone
Email
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Occupation
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The NSW Government requires that we collect occupation information of our members.
accountant
actor
actress
air traffic controller
architect
artist
attorney
banker
bartender
barber
bookkeeper
builder
businessman
businesswoman
businessperson
butcher
carpenter
cashier
chef
coach
dental hygienist
dentist
designer
developer
dietician
doctor
economist
editor
electrician
engineer
farmer
filmmaker
fisherman
flight attendant
I.T Worker
jeweler
judge
lawyer
mechanic
musician
nutritionist
nurse
optician
painter
pharmacist
photographer
physician
physician's assistant
pilot
plumber
police officer
politician
professor
programmer
psychologist
receptionist
salesman
salesperson
saleswoman
secretary
singer
surgeon
teacher
therapist
translator
translator
undertaker
veterinarian
videographer
waiter
waitress
writer
Other (please specify below)
Other Occupation (if required)
Residential Address
Address
*
Suburb
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Postcode
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State
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Country
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Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
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Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Virgin Islands
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Hong Kong, SAR China
Macao, SAR China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Brazzaville)
Congo, (Kinshasa)
Cook Islands
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Côte d'Ivoire
Croatia
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Denmark
Djibouti
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Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Ethiopia
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Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
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Japan
Jersey
Jordan
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Kenya
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Korea (South)
Kuwait
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Liberia
Libya
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Lithuania
Luxembourg
Macedonia, Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint-Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint-Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic (Syria)
Taiwan, Republic of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
US Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic)
Viet Nam
Virgin Islands, US
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Would you like to enter a different postal address
*
Yes
No
Postal Address
if different from residential address
Address
*
Suburb
*
Postcode
*
State
*
Country
*
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Virgin Islands
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Hong Kong, SAR China
Macao, SAR China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Brazzaville)
Congo, (Kinshasa)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Lao PDR
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia, Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint-Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint-Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic (Syria)
Taiwan, Republic of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
US Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic)
Viet Nam
Virgin Islands, US
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Membership Type
Membership Options
*
1 year - $10
1 year pensioner - $9
3 year - $20
5 year - $30
10 year - $50
Perpetual - $100*
* Life Membership
ID and Signature Declaration
ID Number
*
Acceptable forms of Identification include Driver’s License, Photo ID Card and Passport. Please ensure you bring this with you when collecting your card at The Alcott.
Signature Text
Please type in your name
Verification
*
By checking this box I verify that I have digitally signed this membership form.
Signature
DECLARATION
To the Directors, I hereby apply for election as a member of The Alcott. I am 18 years old or over and if elected agree to abide by the constitution and By-Laws of the Club.
Privacy Statement
The Alcott is subject to the provisions of the Privacy Act 1988 (Cth). The personal information provided by you on this form/application and attached documents will be used to process your membership application. Failure to provide all of the requested information may result in your application being rejected. You have a right to access and correct any of your personal information that the Club holds on you. The Club does not usually disclose your personal information to any other organisation or person unless there is a legal requirement to do so. The Club may disclose your information to third parties that are contracted to the Club. These contracts require the third party to keep your personal information confidential and secure. Your personal information, may be used by the Club for marketing purposes to improve our services and to provide you with the latest information about those services and any new related services and promotions. You can opt out at any time.
Membership Refund Policy
Upon cancellation of ones membership, Financial Members are not entitled to a refund or part thereof
Cashless Gaming Terms and Conditions
All persons who play gaming machines in this Club agree they do so subject to conditions of gaming machine play and the following rules which shall be the terms and conditions for use of card-based gaming at North Sydney Leagues Club Ltd group including Seagulls Club, The Alcott and The Greens North Sydney. If you do not agree to these terms and conditions, you must not play the gaming machines or use the card-based gaming functions. The decision of the Club as expressed by its officers and/or employees as to the interpretation of these rules shall be final. The Club, by law, can only issue one player card per person. The person must be over 18. If your card is lost or stolen, you must immediately report this to the Club. A replacement card will be issued once you have completed the necessary declaration required by the Club. You must not have more than one player account open at this Club at any one time. The security of money in player accounts is the responsibility of the both the registered club and the account holder. The government and its agencies take no responsibility for any losses that might occur from the account. An account holder is solely responsible for ensuring that the account holder's personal identification number ("PIN") is kept confidential and that no other person has access to the account holder's player card. The account holder is liable for any losses that might arise from, or in connection with, the account holder's failure to comply with such responsibilities. The account holder may at his/her discretion set a weekly account limit by written request to the Club. The setting of a weekly account limit may also include arrangements for the deactivation of the account card. If a weekly account limit is set the player may alter the limit by written request to the Club. If the player wishes to decrease the weekly account limit, the decrease will take effect within 24 hours of the request being received. If the notice is to increase the weekly account limit, the increase will not take effect until 48 hours after the notice is given to the Club. By participating in card-based gaming at North Sydney Leagues Club Ltd or associated Clubs, you agree and are bound by these terms and conditions, as may be varied by the Club’s member notice board. Monthly player activity statements are available on request, if the account has been active, free of charge. If a player requires a copy of previous activity statements, a charge may apply. You have the option of whether or not you wish to participate in card-based gaming at North Sydney Leagues Club Ltd or associated Clubs at any time. If you do not wish to participate, please notify the Club immediately in writing. Under Section 97 of the Gaming Machines Regulation, 2010, persons issued with a player card have the option of whether or not they wish to participate in the loyalty scheme by the Club. If you do not wish to participate in the player reward scheme at any time please notify the Club immediately. The Club takes no responsibility for any losses the player incurs as a result of playing gaming machines at the Club whether by coin, cash or membership rewards card. The player acknowledges that certain linked jackpots may be electronically transferred to a winning machine’s credit meter. Player accounts are not permitted to hold more than $5,000. If this amount is exceeded you will need to adjust your balance before you account card will operate a gaming machine. The money held in player card accounts is kept separte and not used for any other purposes. Any interest that may be accrued on a player card account fund held by the venue will be distributed to a designated charity. Think about your choices | Call Gambling Help 1800 858 858 www.gamblinghelp.nsw.gov.au
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