Application for membership of Brain Tumour Alliance Australia Inc

(Incorporated under the ACT Associations Incorporation Act 1991 AO 4837)

Entrance fee: $10. Annual subscription: $2

Payment method: Cheque payable in Australian currency to Brain Tumour Alliance Australia Inc or direct debit to BTAA’s bank account: Brain Tumour Alliance Australia. BSB 062900. Account number: 10603153.

Note: We do not have facilities for credit card payments, nor do we offer tax deductible status for donations to BTAA but we can provide a list of recommended Australian brain tumour charities (most of which have tax deductible status) for those seeking to make significant donations for brain tumour research and/or support.

I,

......................................................................................................................

(full name of applicant)

of .....................................................................................................................

(address)

..................................................................................

……………………………………………………………

Telephone contact: ………………………………………………………….

Email address: …………………………………………………………………

(Occupation): ……………………………………………………….

apply to become a member of Brain Tumour Alliance Australia. If I am admitted as a member, I agree to be bound by the rules of the association for the time being in force (N.B. The Rules of the Association are available for download from the BTAA website at www.btaa.org.au )

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(Signature of applicant)

Date: ................................

Nominations (N.B. if you do not know any existing members of the Association leave this section blank and a member of the national committee will contact you.)

I, .....................................................................................................................

(full name)

a member of the association, nominate the applicant, who is personally known

to me, for the membership of the association.

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(Signature of proposer)

Date ................................

I, .....................................................................................................................

(full name)

a member of the association, second the nomination of the applicant, who is

personally known to me, for membership of the association.

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(Signature of seconder)

Date ................................

PAYMENT

Entrance fee ($10)
Annual fee ($2)
Donation to BTAA Inc
Total amount
Method of payment	Cheque Direct debit

Post to:

Treasurer

BTAA Inc

PO Box 76,

Dickson, ACT, 2602