Username* Choose something easy to remember. For example, smithfamily or petersmith Membership card No. FOR OFFICE USE ONLY - please do not enter details in this box.Family Membership - Primary Contact NameThe name of the primary contact for the Family Membership Primary Contact - First Name* The first name of the primary contact Primary Contact - Last Name* The last name of the primary contact Sex*MaleFemaleOther Date of Birth* Contact Details E-mail* Confirm E-mail* Phone* Address Line 1* Address Line 2 City* State* VictoriaNew South WalesSouth AustraliaTasmaniaQueenslandNorthern TerritoryWestern AustraliaAustralian Capital Territory Post Code* Emergency Contact DetailsNippers and Youth memberships only. First Name (Emergency Contact)* Last Name (Emergency Contact)* Phone (Emergency Contact)* Working with Children CheckSome memberships (as outlined on the previous page) require a valid volunteer Working with Children Check. Working With Children Check number (Volunteer check)* Yes - please type number belowN/A for membership typeNo - Application in Progress Some membership types require a valid volunteer Working with Children Check (WWCC), as outlined on the Members Portal page. Please select one of the options. If you do not have a valid WWCC, you can apply here http://www.workingwithchildren.vic.gov.au/ Working with Children Check number Please enter your WWCC card number. Working with Children Check - Expiry Date Please enter the expiry date of your Working with Children Check.Set your password Password* Minimum length of 6 characters. The password must have a minimum strength of Very Weak.Strength indicator Repeat Password* Family Membership - Adult 2 Adult 2 - First Name Adult 2 - Last Name Adult 2 - SexMaleFemaleOther Adult 2 - Date of Birth Family Membership - Child 1 Child 1 - First Name Child 1 - Last Name Child 1 - SexMaleFemaleOther Child 1 - Date of Birth Family Membership - Child 2 Child 2 - First Name Child 2 - Last Name Child 2 - SexMaleFemaleOther Child 2 - Date of Birth Family Membership - Child 3 Child 3 - First Name Child 3 - Last Name Child 3 - SexMaleFemaleOther Child 3 - Date of Birth Confirmation*By checking this box I agree that all details provided by me within this form are true and correct. If the person being registered as a member of the Seaspray Surf Life Saving Club is under 18 years of age, I confirm I am the legal parent or guardian of the above named and have appropriate permission to apply for registration.VerificationLast Step: Are you human? We need to check! If you're not a robot, click the box!*Send these credentials via email.