Clone of PICQ Membership Application

Membership Renewal Form

If you're an existing PICQ member looking to renew, this form is for you.
When did you last pay your membership fee?
Which type of membership would you like to renew?
If applying for a Association or Group Membership
Name of Association or Group
BSB: 484799 | Acct No. 602063280

Account Name: PICQ | Suncorp
Membership Renewal and Receipt
To complete your renewal, please upload a copy of your payment receipt below. This can be a screenshot, photo, or scanned copy. Paid at a Suncorp branch? Simply take a photo of your deposit receipt and upload it here.

Please use the following payment reference when making your payment:
REN [Your Name] e.g. (RENJohnSmith)
Upload Receipt

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Update Personal Details
Title
DOB

MonthDayYear
Full Name

First NameLast Name
E-mail
example@example.com
Phone
Pacific Island Country of Affiliation
Address
City
State
Proof of QLD Residency
Membership is only available to Queensland residents. Please upload a copy of one of the following documents to verify your Queensland residency status. You can use a recent:
- Utility Bill
- Centrelink receipt/correspondence letter
- Valid QLD drivers license
Upload your proof of QLD Residency

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Declaration
I hereby declare that all information provided in this form is true, correct and complete. I understand that providing false or misleading information may result in cancellation of membership.
Signature
Should be Empty:

Membership Renewal Form