Membership Application Form

Member's name

Title

Preferred given name

Family Name

Second family member's name (if applying for family/couple membership)(1)

Title

Preferred given name

Family Name

Address*

Street Address Suburb City State / Province / Region Postal / Zip Code Country

E-mail*

Email confirmation*

Phone-Area Code

Area Code

Phone Number

Mobile Phone:

Payment Single Choice

Adult with online Newsletter $40

Adult with posted Newsletter $45

Family with downloaded Newsletter $45

Family with posted Newsletter $50

Optional extras (price includes postage)

Name Tag $13.20

Extra name Tag $11.00

Badge $8.20

Donation (voluntary)

Total

Payment Options

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