Pro-Choice Union - Foundation Membership Form
Complete the below fields to become a founding member of the Pro-Choice Union
Personal Details
Given Name
First Name
Last Name
Given Name
First name
Surname
Last name
Email - Personal
example@example.com
Mobile Phone
Please enter a valid phone number.
Gender
Please Select
Female
Male
Other
Prefer Not To Disclose
Age
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State (personal address)
Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
State
Employment Status (choose one)
*
Full time
Part Time (or under 25 hours per week)
Unemployed
Employment Details
Organisation
Position
Employee Number
Work Address
Street Address (Work)
Street Address Line 2 (Work)
City (Work)
State / Province (Work)
Postal / Zip Code
State (work)
Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
State (Work)
Please select your payment preference
*
$1.62 per week
$7.00 per month
$84.00 per annum
Please select your payment preference
*
$4.04 per week
$17.50 per month
$210.00 per annum
Please select your payment preference
*
$6.73 per week
$29.17 per month
$350.00 per annum
Our Pro-Choice Union Vision
Pro-Choice Union is a union of today, made by the people for the issues regarding the people. We listen to the voices of our members and fight for what is right and the policy in which they believe.
Please acknowledge the following
I acknowledge and support the creation of the Pro-Choice Union. I acknowledge and accept that a one-off foundation fee of $100.00 will be payable by me within 30 days of the registration of the Union. Payment of the fee will give me foundation member status entitling me to a 30% fee reduction for the first three years of membership and 15% fee reduction for every year after so long as I maintain continuous membership. I acknowledge that on registration of the union I will be required to pay membership fees. Membership fees will be paid by a direct debit I will set up for payment of fees made weekly, fortnightly, monthly or annually at my discretion. Membership fees will be paid in the amount of $500 annually for full time employees and $300 annually for part-time employees.
Please verify that you are human
*
Submit
Upon submission your browser will open a payment gateway to complete your Foundation Membership Registration.
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