HMAS Perth National Association Inc


Membership Application
(Please print this page and complete the printed form for mailing)


Surname: .......................  First: .....................  Init: ......

Preferred (or nick) Name:  .............................

Street:  ....................................................................

Suburb:  ........................... State: ............

Partner's First Name:  .................................

P/code:  ............ Country: .........................

DOB:     ........................

Phone(home):   ........................ (inc A/C)

Phone(work):   ........................ (inc A/C)

Phone(mobile): ........................ (inc A/C)

FAX:           ........................ (inc A/C)

Official No: ...........................  Rank/Branch: .....................

I would prefer to receive my PUNDIT (newsletter) by E-Mail  .....Y  .....N
(please tick)

Time on PERTH:
1.  From (mm/yy): .................... To (mm/yy): ....................

2.  From (mm/yy): .................... To (mm/yy): ....................

3.  From (mm/yy): .................... To (mm/yy): ....................

E-mail Address: .......................................................

Membership costs AU$20 per year, from 1 July to the following 30 June.
Membership for ex-PERTH (1) personnel is free
Associate membership is also available at AU$20 to next-of-kin and spouses
of PERTH personnel.

..... I have made a payment of AU$20.00 by DIRECT CREDIT, to:
HMAS Perth National Association Inc
BSB #   062208      Acct #   10001173
or
Please find enclosed a ... Cheque    ... Money Order for AU$20.00
being for one years' membership of the Association
Please make payable to:  HMAS Perth National Association Inc

Please note that if you use DIRECT CREDIT, you must include your First name, Last name
and the reason for payment  (eg membership)

Please complete this form and mail, together with your cheque, money order or
Direct Credit receipt for AU$20.00 to:

The Membership Secretary
HMAS Perth National Association Inc
PO Box 626
MERIMBULA   NSW   2548