2025 Membership Application
To apply for a 2025 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
1 year Membership- Family
2 Adults & 2 Children (17 and under)
$
200.00
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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
Back
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.
*
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