Membership Application Form

I acknowledge that I have read The Constitution

Yes

All prospective members of the JuvDet Association are required to complete this registration form

JuvDet Membership Application Form

Please tick appropriate boxes

New Member

Notify Change of Address

Member Contact Information

Gender

Male

Female

Date of Birth

Title

Mrs

Miss

First Name

Last Name

Address Details

Legislation requires certain industrial related matters must be voted on by registered members of an Industrial Organisation through a ballot. Ballots are conducted by the Australian Electoral Commission. To have your say please ensure the address you supply JuvDet Association is the same. This address will be placed on our member register as required by law.

Address

Suburb

Postcode

State

Home Phone

Mobile

Communication Strategy

Our ability to contact and inform every member of issues or concerns must be independent from the work place. Please complete any or all methods.

Email address

Skype

Facebook

Nomination of Beneficiary

In the event of my death please pay my benefit to my nominee as detailed below:

First Name

Last Name

Current Address

Suburb

State

Postcode

Relationship

Phone

Membership Fees

By checking this box does not express or imply full membership to you. Your nomination will be considered and approved in accordance to rule 12(a) of the constitution. When you are contacted you will have 4 weeks to pay the joining fee.

Member

Full Member: $40 Joining Fee / $15 per fortnight

Ordinary Member: $15 per fortnight

Method of Payment

JuvDets Banking details: Account Name: Juvdet Association BSB: 633-000 ACCOUNT NUMBER: 152615423

I would like to pay ...

$15 per Fortnight

$360 Annual

Payment Method

Direct Debit

Electronic Funds Transfer

Click here to set up Payment (this will open up in a new window)(your reference is your name i.e D. Duck)

Expiry Date

3 Digit Code

Located on back of your Credit card. Last 3 digits

JuvDets Banking details:

Account Name: Juvdet Association BSB: 633-000 ACCOUNT NUMBER: 152615423 Please use your First initial followed by your family/last name as YOUR reference to the Juvdet Association eg. Donald Duck would be D. Duck as your reference

By checking this box I hereby apply to become a member of the JuvDet Association. I agree to abide by the rules of the Association as set out in its Constitution. I confirm that the information completed in this form is true and correct.

This field should be left blank

Please wait...

5 Reasons to Join …

Welcome to JuvDet Association