The Order of Australia Association

To celebrate and promote outstanding Australian citizenship

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Membership Application

Title *

Name *

First

Last

Address Line 1 *

Address Line 2

City *

State *

Post Code *

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Mobile Number

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Email *

Year of Birth *

Having been appointed:

COMPANION
OFFICER
MEMBER

in the Order of Australia

Having been awarded:

THE MEDAL of the Order of Australia

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

I wish to be associated with the following branch: *

ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Europe
North America

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

an Annual Member by annual payment of $77.00
three years 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

Tick this box to receive The Order (national magazine) in e-version quarterly

Total Amount

$ 0.00

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