RSL-SA,NT Application for Membership
RSL Darwin Sub-Branch
Which type of membership are you applying for?
*
Service Membership
Affiliate Membership
Personal Details
Title
*
Name
*
First Name
Last Name
Post Nominals (Honours / Awards / Decorations):
(Campaign and service medals can be listed later on form)
Address
*
Street Address
Optional - Street Address Line 2
City
State
Postcode
Mobile Phone Number
*
Mobile
Phone Number
Home
Email:
*
example@example.com
Date of Birth:
*
-
Day
-
Month
Year
Sex:
*
Male
Female
Country of Birth:
*
Sex:
*
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Service Details
Sub-Brand Membership Form
Service Number:
PM Keys Number:
Rank:
*
Are you a currently serving member (can be full-time or reservist)?
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Yes
No
Service
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Air Force
Army
Navy
Other
Type
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Regular
Reserve
National Service
Other
Date of Enlistment:
*
-
Day
-
Month
Year
Date
Date of Discharge:
-
Day
-
Month
Year
Date
Discharge Certificate No (if applicable):
Length of Service (Years/Months):
*
Campaign & Service Medals:
Theatres of Operations of Conflicts (select all applicable):
World War 2
Borneo Confrontation
Reserves/CMF
Korea
Peacekeeping
National Service
Malayan Emergency
Somalia
East Timor
Vietnam
Gulf War / Kuwait
Afghanistan
BCOF (Japan)
Regular Forces
Iraq
Other
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Affiliate Membership Details
Are you related to a Service person?
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Yes
No
Service Number:
*
Name:
*
Unit Served with:
*
Conflict:
*
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Previous Membership Details
If applicable
Previous Membership:
*
Yes
No
Date first joined the League:
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-
Day
-
Month
Year
Date
Badge number of previous membership:
*
If applicable
State & Sub-Branch of previous membership:
*
If applicable
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Declaration and Agreement
*
I declare that the above information is true and correct and I agree to uphold the Constitution of the League and its By-Laws.
Signature
*
Date Signed
*
-
Day
-
Month
Year
Date
Privacy Statement
We will not use any of the information on this membership form without your specific permission in writing, other than to record you as a member of the League and will not pass that information to anyone outside the League. ABN 19 219 796 904
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Submit
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