Sign Up - Northerners

Booking Closes for - Season launch

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Postcode*

Phone*

Mobile*

Email Address*

Business Directory Listing Details

Would you like to have your business added to the Northerners business directory*

Business Name*
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Business Address
Business Description
Business Phone*
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Business Web	Eg format: www.northerners.com.au
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Select Member Package*

Add Junior Package(s)

Please tick if you would like to purchase the following add-ons to your package

	Northerners Blazer ($250 per person). Please insert size
	Northerners Business Shirt ($60 per person). Please insert size
	Would you like to sponsor a game? ($1,250 for Collingwood or Carlton, $900 for Richmond, Melbourne, St Kilda or Western Bulldogs and $650 for all other home games). Please indicate preferred sponsored game Please enter game name
	Would you like to sign up for a Northerners online banner advertising package? ($1,450 for 12 month subscription; $950 for 6 month subscription and $600 for 3 month subscription). Please indicate preferred subscription
	Would you like to include car parking at each home game? (11 Games $250, 8 Games $185, 6 Games $140, 5 Games $115, 3 Games $75). Please confirm if you would like 11 games or 5 games of car parking.
*Additional requirements will be charged separately.
	Would you like to receive newsletters and other information from us from time to time.