A TEST WP Forms - Noosa Heads Jazz Club Inc

Test New Members Sign Up & Payment (ID #4198)

Complete this form with your preferred form of payment - credit card or PayPal. Your membership is valid for 1 year from the date of payment and will be automatically renewed annually unless you contact us to cancel your membership. If you have questions please go to our contacts page and call us or send a message.

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Membership

Price: $ 0.50

Your membership of $20 is valid for 1 year from the date of payment and will be automatically renewed annually unless you contact us to cancel your membership. If you have questions please go to our contacts page and call us or send a message.

Form of Payment - tick one

Credit Card
Paypal

Comment - optional