The Non Smokers' Movement of Australia Inc. - Joining Form 2008

Join Up for Clean Air. Ask a Friend to Join.

Please print this page now. Complete the details and then mail to Box K860, Haymarket NSW 1240 or Fax to 02-9905-8787.

Name: ____________________________________________________________

Address: __________________________________________________________

__________________________________________________________________

Postcode: ________________________________________________________

Phone number: ____________________________________________________

Mobile: _______________________________________________________

Email: ___________________________________________________________

Fax: ________________________________________________________________

Membership category: __________________ Fees: __________ Donation: _______

Tick payment method:

Credit card ____ Direct Debit _____ Cheque attached ____ Send Invoice _____


For Cards only: Issued by: Mastercard/Visacard only please

Expiry date: _________


Number: ________ ________ ________ ________

Cardholder's Signature: _______________________________


For Direct Debit only: Send your direct debit to BSB 062-006 Account 0090-0623 then email your details to nsma@nsma.org.au

For Cheques: Please make cheques payable to the Non Smokers' Movement of Australia.

  The Non Smokers' Movement of Australia.
Current fees are Individual $50, Household $70, Concession $25 and Corporate $220.

[Home Page] [About Us] [Fees Explained] [Why Join] [Meetings and the Committee] [Top]