Membership Form

Membership to CAN is:

Full $20.00
Concession $10.00 (Pensioners, Students, Unemployed)

Please use this form to request new membership or to renew membership to CAN.

YOU MUST HAVE AN EMAIL ADDRESS TO USE THIS FORM!

After completing and submitting this form, you will be required to pay your membership using one of the payment options below.

PAYMENT OPTIONS:

1. Internet Transfer:

Climate Action Newcastle

BSB: 650 000

A/C: 980841402

REF: Your Name (ie. John Smith)

2. Cheque/Money Order using Australia Post:

Climate Action Newcastle
PO Box 2359
DANGAR  NSW  2309

3. Cash/Cheque deliver in person:

Use this option if delivering your payment

in person at a CAN Meeting.

 

After receipt of your payment, your request will be processed, and after acceptance of your request, you will receive your reciept by email.

Thank you for your support in becoming a member of CAN.

New Member: *

Yes

No

Please select one

Renew Membership: *

Yes

No

Please select one

Payment Options: * select...Internet TransferAustralia PostDeliver to CAN Meeting

First Name: *

Last Name: *

Email: *

Please enter a valid email address. example: johnsmith@emailserver.com.au

Main Phone: *

Please enter your main contact phone number. If your mobile is your main contact number, enter it here.

Other Phone:

Please enter a secondry contact phone number here if you want to.

Postal Address: *

Street address preferred. PO Box accepted.

Suburb, Town, City: *

State: * select...ACTNSWNTQLDSATASVICWA

Postcode: *

Membership Type: * select...Full $20Conc $10

Donation: select...$5$10$15$20$25$30$35$40$45$50$100$200$300$400$500$1000

Total Amount Payable: * $ .00

Please add membership and donation and enter the total here.

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