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Application for Membership or Renewal
To support Ausflag, please print out this application form, fill it in, and post it with your cheque or money order to:
The Secretary, Ausflag Limited, PO Box 500, Neutral Bay, NSW 2089
Or if you are paying by credit card you may fax it to us on (02) 9909 8277.
Thank you for your support!
PLEASE USE BLOCK LETTERS
Name: ___________________________________________________________________
Address: _________________________________________________________________
Postcode: _____________ Telephone: ____________________________
Annual Membership Categories
PLEASE TICK WHICHEVER CATEGORY IS APPLICABLE
[.. ] $25 Ordinary
[.. ] $10 Pensioners/Students
[.. ] $100 Corporate
[.. ] Donation $ __________
I enclose my cheque, money order, or card number for $ __________ payable to Ausflag Limited.
Please tick:
[.. ] Bankcard
[.. ] Mastercard
[.. ] Visa
Card No: ___ ___ ___ ___ | ___ ___ ___ ___ | ___ ___ ___ ___ | ___ ___ ___ ___
Expiry Date: ___ ___ | ___ ___
Signature: ______________________________________________________________