Application for Renewal of Membership

ORA Membership Renewal

One form for each Member renewing
Your Name:*

First NameLast Name
Partners Name:

First NameLast Name
Home or Postal Address:*

Street Address

Street Address Line 2

CityState

Postcode
Preferred e-mail:*
Preferred Telephone:*
Home or Mobile
Date of Birth:*

DayMonthYear
Date
ORA Badge No:*
eg. Membership No issued on joining the Association
All fees are payable by Direct Deposit to WESTPAC - Ops Room Association Inc.

WESTPAC BANK - BSB: 037-604. ACCOUNT NO: 334430.

Please put Surname and Initials in the comments line on your Direct Deposit with your Bank.

A receipt number, will be emailed to you once monies have been received by the Ops Room Association.

Thank You!

Secretary

Ops Room Association Inc.
Subscriptions:*

1 Year Plan - $15.00AUD2 Year Plan - $30.00AUD3 Year Plan - $45.00AUD4 Year Plan - $60.00AUD5 Year Plan - $70.00AUD
Fees Deposited:*
Amount you have deposited into the ORA Account.
Comments:
Enter here anything you think we may need to know?
Office Use Only:
Date Deposit Received
Receipt No Issued
Date emailed
Should be Empty: