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NATIONAL SERVICEMEN'S ASSOCIATION OF AUSTRALIA

New South Wales Branch Inc.

201_ MEMBERSHIP RENEWAL

(1st January 201_ to 31st December 201_ )

Renewal of Membership $20.00

PLEASE SUPPLY ALL DETAILS BELOW

 

Member Number:N

Service Number:

Surname:

Other Names:

Date of Birth:  ____ / ____ / ____

Email Address:

Address:

PO Box:

Suburb/Town:

Post Code:

Home Tel:

Mobile:

Work Tel:

Fax:

Please show your nominated National Service Sub-Branch:

_______________________________________________________

Or have your name placed as a member of the State Office: 

Sub-Branch Stamp

 

 

       

 With reference to the Privacy Act, do you AGREE or DISAGREE for your details being made available to any other organisation?

PAYMENT:  Please pay directly to your Sub-Branch.

CHEQUES MUST be made out to:    The National Servicemen’s Association of Australia, NSW  Branch Inc.

                                                                                     PO Box 401

                                                                                                                  MITTAGONG NSW 2575