APS Keilor Plains Group - Membership Form
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
Your answer
Family Name
Your answer
Postal Address
PO Box or unit, house number and road/street.
Your answer
Town/Suburb
Your answer
Postcode
Your answer
Telephone (Home)
Your answer
Telephone (Mobile)
Your answer
Email Address
Your answer
Postal delivery of The Keilor Plains Group Newsletter
The Keilor Plains Group Newsletter will be delivered to the e-mail address you have supplied. For postal delivery, select "Yes"
Are you renewing your membership or joining for the first time?
(By answering this question you are agreeing to be bound by APS Victoria and the Keilor Plains District Group Rules and Bylaws)
Please indicate the membership category you desire.
(Each category includes the Keilor Plains District Group Fee of $10)
Please indicate how many years you'd like to join for.
(NB. the amount payable will be the annual fee x number of years; e.g. Household membership x 3 years = $135)
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 "family name/MEMBER"
Emergency Contact Person
Please give the name and telephone number of a person we should in an emergency.
Your answer
Emergency Contact Phone Number (Home)
Your answer
Emergency Contact Phone Number (Mobile)
Your answer
Next
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