Membership Application Form

Fill in your details and print the page or print the blank form and complete it in BLOCK LETTERS.

Last Name:

Given Name:

Address:

Suburb/town:

Post Code:

Telephone:

Mobile:

Email:

Membership (tick if applicable)
(full/concession/student/organization)

1 year membership ($30/15/$5/$100)

Donation

I would like to make a donation of $

Total amount payable: $

For new membership applications: By signing this membership application form I certify that I agree with the objectives of SAWA-Australia (SA) and undertake to abide by its constitution.*

Signature: .................................................


Date: ......................................

Volunteering
I am interested in assisting SAWA-Australia (SA)in its work through

fundraising/merchandise event organization lobbying / letter writing

other (please specify) ...................................................................................

Please send the completed form with your cheque and/or money order made out to SAWA-Australia to
SAWA-Australia (SA), P.O. Box 90, Flinders University Post Office, BEDFORD PARK SA 5042.
If your payment is for new membership you can also mail the completed form and pay your membership fee online (under renewal of membership).