Membership Application | The Order of Australia Association

Member Application Form

Title *

Name *

First

Last

Address Line 1 *

Address Line 2

City *

State *

Post Code *

Country *

Mobile Number

Phone Number

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 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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