Application for Membership of Pets and Positive Ageing Inc.
Please complete the form below and email to info@petsandpositiveageing.com or post to PO Box 400 Curtin ACT 2605.
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
To keep you up to date we will send you information of interest to our members. Please tick the box below if you are happy to receive information by email.
Yes
No
Age group (optional)
18-50
51-64
65 +
Prefer not to say
Where did you hear about PAPA?
Membership Type - annual membership is for one year from 1st July. If you become a memberon or after 1st July the membership is payable within 4 weeks of becoming a member. There is no pro-rata membership rate.
Individual $25
Pensioner/concession card holder $15
Incorporated association $50
Family $30
Payment Method
Cash
Cheque or money order (payable to Pets and Positive Ageing Inc.)
Bank transfer to BSB: 633 000 Account: 151653433
Paypal - please contact us for an invoice
Submit
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