MEMBERSHIP APPLICATION FORM
Select Membership Type
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Adult - $60
65+ - $45
65+ (Two Persons) - $60
Not for Profit Organisation - $65
Company - $85
Student - $17
Family - $80
Your Name
Title
* First Name
* Last Name
Title
* First Name
* Last Name
Student ID No.
Business Name (if applicable)
Contact Information
Email Address
Confirm Email Address
Contact Phone Number
Address
Street name and number
Suburb
City
Region
Post Code
PO Box
How did you hear about us?
Privacy Act Declaration
I understand that the information I have given will be used for the general purposes of Association administration and membership benefits. The Privacy Act gives the right to access this information and to correct if necessary. Photos of members at OSA Functions and Events may be used for website and media purposes. Please advise us if you do not wish your image to be published.
I consent to becoming a member of Otago Settlers Association Inc.
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