Vendor Registration

Username*

Username*

Email*

Email*

First Name

First Name

Last Name

Last Name

Store Name*

Store Name*

https://healthclubstore.jcumsa.org.au/store/[your_store]

Store Phone*

Store Phone*

I have read the JCUMSA 'Health Club Store' Terms and Conditions and agree to abide by its rules and regulations.*

I have read the JCUMSA 'Health Club Store' Terms and Conditions and agree to abide by its rules and regulations.*

Password*

Password*

Confirm Password*

Confirm Password*