Tagholder Application Form

Once this form is submitted, an invoice will be sent. Please allow up to 3 working days to receive the invoice. Payments can be made online via the link in the invoice.
Tagholder Details*
- New
- Renew
Current Tagholder type
Tagholder Number
Name*
First Last
Address*
Street Address Suburb State Postcode
Mobile Phone
Home Phone
Work Phone
Email*
Date of birth*
DD slash MM slash YYYY
Emergency Contact Name*
Emergency Contact phone*
Please select any groups that you are a member of*
- Mt Martha Golf Club
- U3A
- Mt Martha Social Golf Group
- LAC
- Monday Morning MMSGG
- Casual Player
Tagholder Type*
- 12 Month 7 Day
- 12 Month 5 Day
- 12 Month Junior
- Lifestyle Initial 200 Points
- Lifestyle Initial 120 Points
Requested Start Date Of This Tag*

Day
Month
Year
Concession
- Yes
- No
Concession Card No.
Pension and Gold DVA Cards only. No Health Care Cards accepted. Proof of valid card must be provided before invoicing.
I would like to receive information about the Course via email, regarding specials, important notices about maintenance and other items of relevance
- Yes
- No
Would you like to use your cashless wallet balance towards your subscription payment?*
- Yes
- No
- N/A
This field is hidden when viewing the form
Promo Code
Please enter a valid Promo Code that can be found in your Due to Expire letter.
By submitting this form, I agree to the terms and conditions of membership found here, and understand that I am hereby bound by the terms and conditions of the membership agreement

Bookings by MiClub