1. Please fill in all following details:

Name ……………………………………… Address ……………………………………… ……………………………………. Phone (mobile) ………………………………………. Email Address ……………………………………….

2. Please tick the relevant boxes:

I would like to make a contribution to the following membership package

Opt A ���� $50 The Greys Package

Opt B ���� $130 The Bob Neil ‘Legend’ Package

Opt C ���� $300 The Fred ‘Chocka’ Bloch Package

Opt D ���� $350 Player Sponsor

3. Payment Details (please tick one box below):

Opt 1 � Cheque / Money Order,

� Mark as payable to ‘The Adelaide University Football Club’ � Forward with this form to AUFC, GPO Box 3130, Rundle Mall SA 5000

Opt 2 � Eftpos

� Account: Adelaide University Football Club � BSB: 182-512 Account: 961 846 631 Reference: Your name

Opt 3 � Mastercard / Visa – please circle

Card Number _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _

Card Expiry Date _ _ / _ _

CVC Number _ _ _ (on back of card)

Cardholder’s Name ………………….……………………………….

Cardholder’s Signature ………………….………………………………..

4. You can send this form back to AUFC, GPO Box 3130, Rundle Mall SA 5000 or email to sponsorship@bobneil.com. Alternatively you can buy online by visiting the Blacks Store at www.bobneil.com

THANK YOU FOR YOUR SUPPORT OF THE A.U.F.C.