ALSO FOUNDATION MEMBERSHIP FORM

To become an ALSO Foundation Member :

Complete the following form and click the button at the bottom right of this page to become a member of the ALSO Foundation.

Membership and renewal fees are in accordance with the schedule listed below. Amounts are expressed in Australian dollars and will be charged to your credit card as specified by you. Members can also use this form to make a donation. Non members can use the online donation form.

All details submitted on this form are considered confidential and are encrypted across the Internet for your privacy. Your contact details may be used to verify your membership or renewal order.

APPLICATION FORM




Submission type
New membership
Renewal - membership number


I wish to be a
Full Voting Member at $35 per year (includes GST)
Concession Voting Member at $10 per year (includes GST)
Supporting Member
Reciprocal Membership - FREE to Membership Based Community Groups allowing ALSO free reciprocal membership of their group only)
Commercial Membership at $50 per year (includes GST)








Title
Organisation / Business:

Mr Ms Other

First name
Last name

Partner First Name


 Partner Last Name
Postal address


Postcode
 State / Province
 Country

Home phone with area code


 Work phone with area code
Mobile


 Fax with area code
Email address
I identify myself as:
Gay Lesbian Bisexual Transgender Heterosexual
Other (pls. specify) 

Date of Birth
e.g. 31-01-1965
Your date of birth
 Partner's date of birth

Or your age group
-18   18-29   30-39   40-49   50-59   60-69   70+

Occupation


Partner's occupation



I was introduced to ALSO by


Membership number



Donation

Project allocations
Youth Services & Programs
Older Persons Services & Programs
General Support Services & Programs
Rural Services & Programs
Drug & Alcohol, Education & Prevention

Other

Monthly donations
Commencing on the1st day of next month, I wish to make a monthly donation by authorising ALSOCARE to debit my Credit Card account (as per details below) on the 1st of every month until further notice . Accordingly, please debit my account with $ per month. I understand that a receipt for the total amount I have donated in a financial year will be forwarded prior to 30th June each year. Submission of this form will indicate your authorisation of this arrangement (until cancelled in writing).

Single donation
I wish to donate $ to ALSOCARE & Benevolent Society Inc. (Donations $2 and over are tax deductable)

Payment
Please debit my Credit Card with $ ( Total Membership fee and/or donation - all amounts Australian dollars)
I do NOT wish my Donation to be Publicly Acknowledged.


Credit card
Visa
Mastercard


Card number
 CVV Number*
 Name on card
Please leave spaces between digits as they appear on your credit card.
* Financial Institutions are increasingly issuing credit cards with a number printed on the reverse of the card. This is an expanded version of your Credit Card Number with an additional 3 digits at the end. These 3 digits is your CVV number.

Expiry date
Month Year    

 Card Issuer / Bank
DECLARATION
In the event of admission as a member, I agree to be bound by the objectives and rules of the ALSO Foundation.

Submission of this application and payment of Membership Fee signifies that I have read and agree to abide by the ALSO Foundation Primary Aims and Objectives.

Any comments?


   

Click the 'Submit Application' button to send your completed form. Please verify your details on this form are correct.
ALSO Foundation home page


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