Name (your given and family name)

e-mail address

Street address

Suburb

Post code

State

Telephone number

Existing AGA membership number - for renewals only

Your rank (e.g. 4kyu, 2dan)

Date of birth (for under 16 year old's only)

Your regular Club

Gender - used when selecting players for International Tournaments

Australian Citizen (Y/N) - used when selecting players for International Tournaments