GOLD COAST JAZZ & BLUES CLUB Couples Membership Application Note: For couples who share the same Email Address and/or the same Postal Address, just enter ‘As Above’ in the partner’s section boxes for this information. *** Annual Memberships now available *** Your Email Address Your First Name Your Last Name Your Date Of Birth Your Phone (Mobile Preferred) Your Postal Address Your Post Code Partner's Email Address Partner's First Name Partner's Last Name Partner's Date Of Birth Partner's Phone No Partner's Postal Address Partner's Post Code Preferred Payment Method Credit Card / Paypal Direct Bank Deposit At Jazz Club Show Click Here To Register Your New Membership