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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

[.. ] $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: ______________________________________________________________

ACN 008 581 191