Membership Application | The Order of Australia Association

Member Application

Title *

Name *

First

Last

Address Line 1 *

Address Line 2

Suburb/Town *

State/Territory *

Post Code *

Country (if not Aust) *

Mobile Number

Phone Number

Email *

Year of Birth (note Date of Birth) *

This information is required for actuarial purposes

Having been appointed:

COMPANION AC
OFFICER AO
MEMBER AM

in the Order of Australia

Having been awarded:

THE MEDAL of the Order of Australia OAM

I received the award on *

in the year *

I agree to be bound by the Constitution and By-Laws of The Order of Australia Association Ltd which are on the Association’s website at www.theorderofaustralia.asn.au

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Tick the box to receive The Order (national magazine) in e-copy quarterly

I wish to be admitted to The Order of Australia Association Ltd as: *

an Annual Member by annual payment of $77
three year annual member at discounted rate of $200
Lifetime member by either: one payment of $1,155
two instalments of $577.50
four instalments of $288.75

Lifetime Member Certificate is issued after all instalments have been received.

Total Amount

$ 0.00

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