Australian Monarchist League

Membership & Contribution Form

To apply for membership of The Australian Monarchist League or to make a contribution, please complete the following details and press the 'submit' button. You can also copy the form and fax or mail it to us with credit card details, cheque (made payable to The Australian Monarchist League), Money Order or cash to the address provided at the end of the form. If for some reason the 'send' button does not transmit, please copy the form and paste it onto an email and send it to: <monarchy@westnet.com.au> or fax to 61 2 8580-4923. All monies received are receipted.

DETAILS OF MEMBERSHIP

For new members we offer a special six months ‘trial’ internet membership without any charge or obligation whatsoever

Trial members will receive emailed information &

notification of events. Paying members will receive

mailed information as well as email advices

Please indicate which category of membership you are applying for:

	DESCRIPTION
	$00.00 (Trial)
	$30.00 (Basic)
	$500.00 (Life)
	$15.00 (Student)
	$15.00 (Pensioner)

DETAILS OF CONTRIBUTION

I do not wish to join but wish to contribute the following amount towards your activities:

	$	25.00
	$	50.00
	$	100.00
Other amount
	$

CREDIT CARD DETAILS

Total amount charged
Credit Card
Cardholder Name
Card Number
Expiration Date

PERSONAL INFORMATION

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
Fax
E-mail

SHOULD YOUR APPLICATION NOT BE ACKNOWLEDGED WITHIN A MONTH OF TRANSMISSION, PLEASE EMAIL US AT: secretary@monarchist.org.au AS OCCASIONALLY LEGITIMATE EMAILS GET CAUGHT UP BY OUR FILTER SYSTEMS.

PRODUCTS

PLEASE EMAIL THIS PART OF THE FORM

OR FAX TO 61 2 8580 4923

QTY	DESCRIPTION

Name