Become a Member

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Is this a new member application or renewal of existing membership?(Required)

New membership application

Renewal of membership

I wish to apply/renew for:(Required)

1Y Membership $30 (runs from 1st January to 31st December)

3Y Membership $75 (1st January to 31st December of 3rd term)

Other

Your Details

Number of Over-18's Being Registered(Required)

First Name(Required)

Middle Name

It would be helpful to enter this to help us properly identify you

Last Name(Required)

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 Suburb State Postcode

Best Contact Number(Required)

Your Email Address(Required)

If you do not provide your email address, you may miss out on important Samaj announcements

Your Gaam(Required)

Your Partner's Details

Partner First Name

Partner Middle Name

It would be helpful to enter this to help us properly identify you

Partner Last Name

Partner Contact Number

Partner Email Address

Partner Date of Birth

Partner Gaam (Maiden Gaam)

Your Children's Details

Please exclude any children over 18 years of age on this form as they must apply for their own separate membership. We require this information so we can check young members against their parent's membership details

Child 1 Name

Child 1 Date of Birth

Child 2 Name

Child 2 Date of Birth

Child 3 Name

Child 3 Date of Birth

Child 4 Name

Child 4 Date of Birth

Child 5 Name

Child 5 Date of Birth

Nominee 1: Reference Details

New Membership requires nominees to be submitted. Existing renewals, or children of members are not required to submit nominations

Full Name(Required)

Contact Phone No:(Required)

Email Address

Nominee 2: Reference Details

New Membership requires nominees to be submitted. Existing renewals, or children of members are not required to submit nominations

Full Name

Contact Phone No:

Email Address:

Communications/Privacy

I/We agree to be contacted by email as default (you may choose to unsubscribe directly via the 1st automated email message if required)(Required)

I agree

SKLPC WA may publish videos/photos from performances/Events on various SKLPC WA social media platforms. These videos will be available to download. By choosing to agree, you acknowledge that SKLPC WA takes no responsibility for the sharing or downloading of the content by other users.

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My/Our Interests

Art Crafts and Culture

Bowling and Movies

Cookery Food and Eating Out

Dance and Drama

Religion Faith Mandir and Besvanu Announcements

Plants and Horticulture

Professions and Careers

Property Finance and Investing

Students Teaching and Learning Management

Trades Building Mechanical and Commercial

Travel Camping Hiking and Trekking

Volunteering and Charity Work

This is an optional area for you to highlight your interests

Terms and Conditions

By checking the next box, I/We have read, understood and agree to the above Terms and Conditions.(Required)

I agree to the Samaj Terms and Conditions

- 1 year membership 1 January - 31 December ($30 per person over 18) of respective year.
- 3 Year membership $75 ($15 Discount)
- Membership is free for persons under 18 years of age.
- I/We agree to be bound by the Constitution and any by-laws of the Shree Kutchi Leva Patel Community (Samaj) of WA.
- I/We agree to inform the Secretary immediately of any changes to my/our contact details.
- All the information provided in this form by me/us is accurate, true and complete.
- I/We acknowledge and accept that SKLPC WA’s decision to accept or decline my/our application is in its discretion and is final.

- I/We hereby apply to renew/join subscribed membership of the Shree Kutchi Leva Patel Community WA (Samaj)

SKLPC WA may publish videos/photos from performances/Events on various SKLPC WA social media platforms. These videos will be available to download.
By choosing to agree, you acknowledge that SKLPC WA takes no responsibility for the sharing or downloading of the content by other users.

Membership Application Form