OzHPV Inc. Membership Form
Hi there,
OzHPV Memberships fall due at 1st January 2017 and run for 12 months through to 31st December 2017.
We are trialing this Google Form for gathering membership details to make things a bit easier all around.
If you have paid your previous membership at some stage mid year, you may only have to pay the pro rata make up proportion of the annual fee. Please see the separate covering email for details.
Type of Application
Please provide your updated contact and membership information even if you are renewing your existing membership.
Please choose one
About You
First Name
Your answer
Surname
Your answer
Address
Your answer
Suburb
Your answer
State
Postcode
Your answer
Phone Contact Number
Your answer
Email address
Your answer
Legal Stuff
By Checking this box I agree to abide by the rules of association of OzHPV Incorporated.
Required
About your HPVs
Provide details of your HPVs if you like.
Your answer
Your Interests
What are your interests in HPVs?
All OzHPV Newsletters will be distrubuted via Email
If you want to receive the HUFF newsletter by snail mail please add $5 to your annual membership fee
I want to receive my HUFF by Snail Mail (Post)
Membership Fees
All membership fees run from 1st January 2017 to 31st December 2017
Single Member Fee $25 Family/Household Member Fee $35
I have paid my membership fee by:
Amount Paid $$
Your answer
Submit
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