APS Keilor Plains Group - Membership Form 2020 -2021
Please complete form below if you wish to JOIN or RENEW your membership. Then, below this form are details on how to make your payment.
First Name(s) *
If family membership give all names; e.g. Bob, Sue, Jasmine, Toby
Family Name *
Postal Address *
PO Box or unit, house number and road/street.
Town/Suburb *
Postcode *
Telephone (Mobile)
Telephone (Home)
Email Address *
Are you renewing your membership or joining ? *
Please indicate the membership category you desire. *
(Each category includes the Keilor Plains District Group Fee of $10)
Would you subscribe to "Australian Plants" (x 4 issues/year) - $15.00? *
Payment method? *
If "EFT" or "Pay at a Bank Branch" is chosen below, please note that banks details are at the bottom of this form, and include as reference "Surname"
Emergency Contact Person *
Please give the name and telephone number of a person we should in an emergency.
Emergency Contact Phone Number (Mobile)
Emergency Contact Phone Number (Home)
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