SPAN Membership Form

SPAN Membership Application Form

INDIVIDUAL MEMBERSHIP AUD$20 per year (includes 4 issues of Kasama by post in Australia).

STUDENT/PENSIONER/UNEMPLOYED AUD$15 per year (includes 4 issues of Kasama by post in Australia).

GROUP MEMBERSHIP AUD$20 per year (includes 4 issues of Kasama by post in Australia).

DONATION. Cash donations for solidarity work are always greatly appreciated. Please indicate if you wish to contribute to a specific project.

Print out the SPAN Membership Application Form, complete and return with your payment to the SPAN Coordinators at the address below.

MAKE CHEQUES/POSTAL ORDERS PAYABLE TO Solidarity Philippines Australia Network

TO: SPAN Coordinators
Solidarity Philippines Australia Network (SPAN)
Centre for Philippine Concerns
Justice Place, 84 Park Road
WOOLLOONGABBA QLD 4102

I/we agree with the Aims and Objectives of Solidarity Philippines Australia Network and wish to join SPAN.

NAME:                    ..................................................
ADDRESS:            ..................................................
ADDRESS:            ..................................................
TOWN/CITY:          ..................................................
STATE:                   ..................................................
POSTCODE:          ..................................................
HOME PHONE:     ..................................................
WORK PHONE:    ..................................................
MOBILE:                 ..................................................
EMAIL:                    ..................................................

I wish to pay the concession rate as .........................................
(Enter STUDENT, PENSIONER or UNEMPLOYED if paying concession status rate)

I wish to make a donation of $....................

Please find enclosed total payment of $....................*

SIGNED:.........................................................................
DATE:.............................................................................

*MAKE CHEQUES/POSTAL ORDERS PAYABLE TO:
Solidarity Philippines Australia Network