Membership Form

Membership Form

Currently, United is the only approved provider of Aged Care Services for Victoria's Spanish Speaking Community by the Commonwealth Government . As the number of members grows, we can provide broader support in order to extend and diversify our services. Thanks to your contribution, we can support the community and make a positive difference.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Date of birth*

DayMonthYear
Date
Country of birth*
Landline
Please enter a valid phone number.
Mobile*
Please enter a valid phone number.
Email*
example@example.com

I {nameAnd} wish to be a member of the Spanish Latin-American Welfare Center Inc. (UNITED).

In the event of my admission as a member, I agree to abide by the rules of the association.
Signature*

Are you a UNITED employee? * If your answer is yes, you will NOT be able to vote to elect the members of the management Committee.*

YesNo

Do you do volunteer work for United? * If your answer is yes, you do not have to pay the membership fee*

YesNo

Thank you for volunteering with United!

The membership fee for volunteers is $0, but if you want to make any donation, we would appreciate it.
If you would like to make a donation, please enter the amount here*
fill with a zero (0) to not send donation
We appreciate any donation you send us, any donation over 2 dollars can be tax deductible

Details
Membership fee ${membershipFee}
Membership Volunteer fee $0 (1 year)
Donation ${ifYou}
Subtotal
The membership fee for volunteers is $0

Please press the Submit button to proceed
Total fee

prevnext( X )
AUD

Payment Methods

Debit or Credit Card

First Name on the card

Last Name on the card

Credit Card Number

Card Expiration

Security Code

Please click one of the PayPal options to complete payment and submit the form.