I agree to the Brisbane Heat Membership Terms and Conditions as outlined on: brisbaneheat.com.au/membership STANLEY ST VULTURE ST MAIN ST 1: Tell us about yourself Please 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 you Member #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 Options We 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 Admission Upper General Admission MEMBERSHIP APPLICATION IGNITE THE PASSION brisbaneheat.com.au/membership 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-MWR15 PROMOTIONAL CODE: