The Non Smokers' Movement of Australia Inc. - Joining Form 2015

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 these two 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.
For Invoices: Just ask and we will send you an invoice.

  Current fees are Individual $55, Household $75, Concession $30 and Corporate $225.

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