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Annual Membership Subscription / Renewal Form

Please print this membership form, fill in your details and post with cheque or money order to:

ACT Vegetarian Society Inc.
GPO Box 1786
CANBERRA ACT 2601
Ph: 0417 464 675

 

Alternatively, you can register to become a member online by filling in the fields below. If you encounter any problems please email us at contact@vegetariansociety.org.au

Payment method:
(if a current member - Membership number: )
Name:
Address:
Suburb: Postcode:
Country: State:
Home phone: ( )
Work phone: ( )
Mobile phone: ( )
Email address:
 
All memberships receive discounts and newsletters
Type of annual subscription (please select one)
(if you chose a family or organisational membership you need to provide a second name)
Name for additional card:
 
Donation (optional):
 
(For Single, Family and Organisation memberships only)
As a member I would like to receive...
(please tick one magazine OR you may select both for an extra $22)
Vegan Voice
Natural Health and Vegetarian Life
 
 
Signature: _____________________________ Date: / / 2010
 
If you have already paid (via a bank deposit, for example) enter your payment reference
Amount: $ Reference:
Bank account details for direct deposit:
Commonwealth Bank Woden, BSB: 062 908 Account: 1021 3284

June 2010