SLCSWA Membership Application Form

Sri Lankan Cultural Society Of Western Australia

Membership Application Form

Main Applicant

First NameLast Name

Email Address

Spouse

First NameLast Name

Spouse Email Address

First Child's Details

First NameLast Name

Second Child's Details

First NameLast Name

Third Child's Details

First NameLast Name

Residential Address

Street Address

Street Address Line 2

CityState

PostcodeCountry

Home Phone Number

Format: (08) 0000 0000.

Mobile Phone Number

Format: 0400 000 000.

Member Categories

Member Category	Annual Subscription
Ordinary Family	$25.00
Individual	$12.50
Pensioner/Pensioner Family	$10.00
Students (Please prove your eligibility)	Free
First year of WA Resident (Please prove your eligibility)	Free

* Membership is valid from 1st July to 30th June of the following financial Year

Bank Details - (Please upload the EFT receipt below)

ACC Name	The Sri Lankan Cultural Society of Western Australia
Bank	Commonwealth Bank of Australia
BSB	066-164
ACC No	10630801

Select Membership Category

Upload Membership Payment Receipt

Member Declaration

Main Applicant's Full Name

Date

DayMonthYear