Make your own free website on Tripod.com

 

aba logo

AUSTRALIAN BRAVERY ASSOCIATION

 

MEMBERSHIP APPLICATION

 

(OFFICE USE ONLY) MEMBERSHIP N#:  (OFFICE USE ONLY) RECEIVED:

FAMILY NAME:                                                                    POSTNOMINALS: (If applicable)

GIVEN NAMES:                                                    PREFERRED NAME:                                    TITLE:

ADDRESS:

SUBURB:                                                                STATE:                                 POSTCODE:

HOME PHONE:                                                      WORK:                                    MOBILE:

E-MAIL ADDRESS:

OCCUPATION/EMPLOYER

DOB: ....../....../.......                    AWARD RECEIVED:

DATE OF ACT OF BRAVERY: ....../....../.......                DATE OF INVESTITURE: ...../...../......

CITATION: (Please attach a copy)

MEMBERSHIP FEES ARE DUE ANNUALLY BY CALENDAR YEAR.

MEMBERSHIP TYPES:  

ORDINARY MEMBERSHIP $25.00. 

HONORARY LEVEL 1 (Gratis)

ASSOCIATE MEMBERSHIP $15.00.

LIFE SUBSCRIPTION: ($250.00 LIMIT 100)

 

I do hereby apply to become a member of the AUSTRALIAN BRAVERY ASSOCIATION Inc. In the event of my admission as a member, I agree to be bound by the rules of the Association for the time being in force.

The Information I have supplied is available, on a strictly confidential basis, to authorised persons in the Australian Bravery Association Inc. (the Association) for the purposes of the Association ONLY.

I enclose the sum of $....................being my membership subscription.

CHEQUE                 MONEY ORDER                  CASH (Do not post cash)

 

SIGNATURE OF APPLICANT:................................................................................. DATE ....../....../......

 

I,................................................................. .......BEING A FINANCIAL MEMBER OF THE ASSOCIATION here by nominate the applicant for membership of the Association. 

 

SIGNATURE OF PROPOSER:................................................................................. DATE ....../....../......

(PLEASE PRINT NAME AND SIGN)

HOW DO YOU WISH TO RECEIVE NEWSLETTERS         AUSTRALIA POST   E-MAIL

HOW DID YOU BECOME AWARE OF THE AUSTRALIAN BRAVERY ASSOCIATION?

INVESTITURE    WEBSITE       OTHER (Please specify)

 

MONIES MADE PAYABLE TO "AUSTRALIAN BRAVERY ASSOCIATION"

COMPLETE WITH MEMBERSHIP APPLICATION FORM ARE TO BE MAILED TO:

 

mrs hedonna thurgar

NATIONAL MEMBERSHIP SECRETARY/TREASURER

AUSTRALIAN BRAVERY ASSOCIATION

20 COBBY STREET

CAMPBELL ACT 2612

Last Updated 10 Sept, 2008