Application for Individual Membership

Piye Inc.

(Incorporated under the Australian Associations Incorporation Act 2009)

Your Details
Title  Mr Mrs Ms Dr Prof
* Firstname * Surname
* Address
Suburb * Postcode
Phone(h) Phone(m)
Phone(w) * Email
* Country
 
I hereby apply to become a member of the above-named incorporated association. In the event of my admission as a member, I agree to be bound by the rules of the association for the time being in force. I agree to submit within 28 days the AUD$20 one time subscription fee and AUD$50 annual membership fee.
* Sign here or print name  

COMPLETE SECTIONS A OR B BELOW

Section A - Sponsor's Details
Name

I am a member of the association, and would like to nominate the applicant, who is personally known to me, for membership of the association.
Date
Sign here or print name  

Section B - Self Nomination
 I self-nominate for membership of the association
Sign here or print name
 
* Payment Options
 One Time Payment
* I would like to pay amount in   AUD USD EURO
* Amount to be transferred
   
Please note: The donations are not tax-deductible
 Direct Debit/ Bank Transfer
Bank Name: Commonwealth Bank
Bank Location: Sydney, Australia
Account Name: PIYE Incorporated
Account Number: 10484047
BSB#: 062009
Swift Code (Outside Australia): CTBAAU2S
 Cheque/ Money Order - payable to PIYE Incorporated.
Print and mail this form along with your payment to:

The Treasurer
Piye Incorporated
33 Ness Avenue
Dulwich Hill
NSW Australia 2203
 Pay by Credit Card or Bank Transfer via PAYPAL.
(PAYPAL will process amount in AUD)



We would appreciate a confirmation of your donation.
Please email us - info@piye.org.au

Thank you for your support

 


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