2026 Membership Application
To apply for a 2026 membership, please complete the following questions
*
I have read, understood and agree to the rules and regulations of SALMRA. I accept that if I breach the rules disciplinary actions may be taken and membership may be suspended or cancelled. Membership commences once approved and expires 31st December.
Membership Application
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( X )
1 Year Membership- Individual
1 Adult or 1 Child
$80.00 AUD
$
80.00
AUD
1 year Membership- Family
2 Adults & 2 Children (17 and under)
$200.00 AUD
$
200.00
AUD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Ambulance Membership Number
*
(Compulsory)
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1 Year Membership- Individual
1 Adult or 1 Child
Name
First Name
Last Name
Email
example@example.com
Date of Birth
/
Day
/
Month
Year
Phone Number
Previous Membership Number
Leave blank if you are a new member
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1 Year Membership- Family
2 Adults & 2 Children (17 and under)
Number of Adults
Please Select
0
1
2
Number of Children
Please Select
0
1
2
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1 Year Membership- Family
2 Adults & 2 Children (17 and under)
1st Adult
Name
First Name
Last Name
Email
example@example.com
Date of Birth
/
Day
/
Month
Year
Phone Number
Previous Membership Number
Leave blank if you are a new member
2nd Adult
Name
First Name
Last Name
Email
example@example.com
Date of Birth
/
Day
/
Month
Year
Phone Number
Previous Membership Number
Leave blank if you are a new member
1st Child
Name
First Name
Last Name
Email
example@example.com
Date of Birth
/
Day
/
Month
Year
Phone Number
Previous Membership Number
Leave blank if you are a new member
2nd Child
Name
First Name
Last Name
Email
example@example.com
Date of Birth
/
Day
/
Month
Year
Phone Number
Previous Membership Number
Leave blank if you are a new member
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Next
Review
By submitting a membership application, you agree all details provided are correct. I have read, understood and agree to the rules and regulations of SALMRA. I accept that if I breach the rules disciplinary actions may be taken and membership may be suspended or cancelled. Membership commences once approved and expires 31st December.
*
Submit
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