Membership Application / Renewal

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Submitted by Anonymous on 2 July 2010 - 12:30am

I/we wish to join/renew membership of the APA of NSW for the period: *

July 2011 - June 2012 at $30

July 2011 - June 2013 at $55

Family Name (Surname): *

Husband Details

First Name: *

Last Name: *

Wife Details

First Name: *

Last Name: *

Child/Children's names and Date of Birth

Child 1:

Child 2:

Child 3:

Child 4:

Child 5:

Contact Details

Email Address:

Residential Address:

Postal Address (if different):

Home Phone:

Mobile:

APA Sub-Groups you might be interested in

(please indicate one or more)

Sub-groups:

Kids Club Sydney

Kids Club Regional

Adoptive Parents Pool

General Membership

Exchange of Contact Details

We are happy for exchange of information with other members in our kids club / pool sub-group:

Yes

If Yes, what information are you happy to exchange?:

Surname

Given Names

Address

Phone

Payment Options

Bank Transfer:

Bank Transfer

PLEASE INCLUDE YOUR SURNAME AS REFERENCE AND RETURN FORM BY POST OR EMAIL.
BSB: 062 281 (Commonwealth Bank)
Account Number: 00904354
Account Name: Adoptive Parents Association of NSW Incorporated

If you opt to pay by a cash deposit into this account, you MUST immediately notify the APA of the details of your transaction.

Cheque:

Cheque

Make out cheque to Adoptive Parents Association of NSW Inc.
Post this form with the cheque to the address in the top right hand corner.

Application Due Date:
August 15, 2011

Annual Membership is from:
July-to-June

Membership Fees:
$30 one year / $55 two years