Membership and Donation

Title

Your First Name

Your Last Name

For Couples Membership

Your Email

Street/PO Box

Suburb

PostCode

State/Territory

ACTNSWVicTasSAWAQldNT

Phone

Year of Birth (optional)

Type of Membership

Annual Single $35Annual Single Concessional $25Annual Couple $60Annual Couple (Concessional) $45Single Life Membership $300Couple Life Membership $500Donation
*concession rates apply to means-tested pensioners

Are you

Renewing your membershipA New memberMaking a donation

Select your payment method

Direct Bank TransferCheque
Date of Bank Transfer

Bank Details:
The email acknowledging your lodgment of this form will contain details of our bank account

Cheques to:
PO Box 55
Waramanga ACT 2611