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ABN 69 283 023 920

AUSTRALIAN BRAVERY ASSOCIATION

 

MEMBERSHIP RENEWAL

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

FAMILY NAME:                                                                 POSTNOMINALS: (If applicable)

GIVEN NAMES:

PREFERRED NAME:  TITLE:

ADDRESS: 

SUBURB:                                            

STATE:       POSTCODE:

HOME Ph: 

WORK Ph: MOBILE:

E-MAIL ADDRESS:

OCCUPATION/EMPLOYER

DOB: ....../....../....... (Over 70 Years Fees Waived)  AWARD RECEIVED: (IF ADDITIONAL)
CITATION: (IF AN ADDITIONAL AWARD PLEASE ATTACH A COPY OF CITATION)

MEMBERSHIP FEES ARE DUE ANNUALLY BY CALENDAR YEAR

MEMBERSHIP TYPE:

ORDINARY  $25.00.

ASSOCIATE  $15.00.

HONORARY  $25.00.

ORDINARY 5 YEAR $50.00.  

ASSOCIATE 5 YEAR $50.00.

LIFE SUBSCRIPTION: $250.00

 

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. 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 ....../....../......

 

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

 

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 May, 2007