Please complete the form below and click the 'submit'. You will then be taken to the secure shopping cart area and your fee payment will be organised online.

If you would prefer not to pay online, please click here for a copy of the form you can fax/post to LBHM.
If you have any queries, please click on the 'contact' link at the top right hand side of the screen.

Title:	Mr Dr Ms Other/None
First Name:			Last Name:
Email Address:	(most communication for LBHM is via email)		Phone:	(##-####-####)
Mobile:	(####-###-###)		Work Phone:
Address 1:
Suburb:			State:
PostCode:			Country:	Please Select One Argentina Australia Austria Brazil Canada China France Greece Germany Hong Kong India Indonesia Ireland Italy Japan Korea Mexico Netherlands New Zealand Philippines Poland Russia Singapore South Africa Spain Sweden Switzerland Taiwan United Kingdom United States Other (please specify)
Date of Birth:	Please use the format dd/mm/yyyy		Did someone refer you to LBHM? If so, put their name in here
T-Shirt Size:	If signing for a full membership, you will receive a free LBHM T-Shirt. Please specify the size your t-shirt should be.			Small Medium Large Extra Large Extra Extra Large Long Sleeve Short Sleeve

The following information is optional, but would be appreciated to ensure we are offering the right services to our members.
All information gathered remains completely confidential.

Do you have children?	If Yes, How Many?	0 1 2 3 4 5 6 7 8 9
	What age range are your children?	eg.2-6 or 10-19
What are your interests?	Sports. If ticked, what type of sports?
	Ourdoor Recreation
	Socialising
	Hobbies
	Other. Please specifiy
Occupation?
Industry?
Membership Type:	There are two membership levels to choose from. Please select one below:
	Standard Membership	FREE Membership card and key ring with individual identification number Bumper sticker Full site access Access to events and merchandise at member prices
	Full Membership	$25 (including postage, and GST). Membership card and key ring with individual identification number· Bumper sticker Full site access Access to events and merchandise at member prices Long sleeve LBHM T-shirt (normally $20 + $5 postage) E-mail or newsletter updates on League news. Priority access on event tickets