Membership and Donation Complete the form below to join, renew &/or donate. 1. About You 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) 2. Type of membership 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 3. Payment Method 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 4. Lodge your completed form Need a paper based form? Click here to download a paper form.