I agree to the Brisbane Heat Membership Terms and Conditions as outlined on: brisbaneheat.com.au/membership

S T A N L E Y S T

V U L T U R E S T

MA

I N S

T1: Tell us about yourselfPlease complete this entire section and Part Two if other people are joining with you (individuals or family members). Note: we are unable to process your membership if details are missing.

Title First Name Surname

Postal Address

Suburb State Postcode

Phone (H) Phone (M)

Email Gender: M / F

Date of Birth Local Cricket Club

2: Tell us about anyone else joining with youMember #2 Title First Name Surname

Gender: M / F Email Date of Birth

Member #3 Title First Name Surname

Gender: M / F Email Date of Birth

Member #4 Title First Name Surname

Gender: M / F Email Date of Birth

Member #5 Title First Name Surname

Gender: M / F Email Date of Birth

3: Select your Membership

KEY MEMBERSHIP ADULT QTY CHILD QTY CONC QTY FAMILY(2A+2C) QTY FAMILY

(2A+3C) QTY FAMILY(2A+4C) QTY TOTAL $

Luxe Lounge $380 $380 $380 N/A N/A N/A

Hot Spot $240 $240 $240 N/A N/A N/A

Gold Reserved$130 $115

$50 $40

$90 $70

$310 $270

$330 $285

$360 $310

Boundary General Admission $90 $35 $65 $215 $245 $265

Upper General Admission $90 $35 $65 $215 $245 $265

Supporter $30 N/A N/A N/A N/A N/A

Total $

Refer to map below for seating locations

Please note: • All prices are GST inclusive • Please refer to the Brisbane Heat website for Concession eligibility conditions • Child pack not applicable to Supporter memberships.

5: Payment OptionsWe accept MasterCard, VISA, cheque or money order payments. All cheques are to be made payable to Brisbane Heat.

5.1: My Payment Details

Credit Card*

First Name

Credit Card Number

Signature

CVV

Expiry Date

Last Name

4: Seating Request (for Gold Reserved Memberships only)

Please indicate any seating preferences below i.e. to be seated near an aisle or next to someone who is joining via a separate form:

Luxe Lounge

Hot Spot

Gold Reserved

Boundary General AdmissionUpper General Admission

M E M B E R S H I P A P P L I C A T I O N

I G N I T E T H E P A S S I O N b r i s b a n e h e a t . c o m . a u / m e m b e r s h i p

Online: www.brisbaneheat.com.au - VISA or MasterCard only.

Phone: 1800 GO HEAT (1800 464 328) – VISA or MasterCard only.

In Person: visit us at Queensland Cricket - 1 Greg Chappell Street, Albion QLD between 9am and 4.30pm, Monday to Friday (VISA, MasterCard, cheque, money order, EFT, or cash accepted).

By Mail: please send completed form with payment to: Brisbane Heat Membership, PO Box 575, Albion QLD 4010 (VISA, MasterCard, cheque or money order accepted).

VISA

Total amount due: $

MasterCard Money order Cheque EFT

BNEHT-MWR15PROMOTIONALCODE: