Annual membership application

Ludlow memberships

Persons name *

First name

Last name

Mobile *

Email address *

I can volunteer

Please let us know if you can volunteer in any capacity

Yes

Skills & knowledge

Please let us know if you have any skills or knowledge that may help our group.

Other person (Same household)

First name

Last name

Mobile

Email address

I can volunteer

Yes

Skills & knowledge

+ Add another member

Address *

Address line 1

Address line 2

City/Suburb

State/Territory

Postcode

All individual members except concession card holders

	Quantity	Price	Total
Individual membership (1 year)		$35.00	$

	Quantity	Price	Total
Individual membership (3 years)		$95.00	$

One adult and their partner and all children from birth until they turn 18

	Quantity	Price	Total
Family membership (1 year)		$60.00	$

	Quantity	Price	Total
Family membership (3 years)		$160.00	$

All individuals holding a seniors card

	Quantity	Price	Total
Senior membership (1 year)		$30.00	$

	Quantity	Price	Total
Senior membership (3 years)		$80.00	$

Any individual who is studying full-time, or an individual who holds a current Australian or WA Government concession or healthcare card. Note: 3 years memberships not available with this category.

	Quantity	Price	Total
Student/Concession membership (1 year)		$30.00	$

Total amount

Payment *

Stripe - Credit & Debit Cards

Bank deposit (General)
Make deposit to account
633000 162355705