Lighthouses of Australia Inc. Membership Application
Lighthouses of Australia Inc.
PO Box 4734
KNOX VIC 3152 Australia
ABN 80 892 357 539
keeper@lighthouse.net.au
www.lighthouse.net.au

To apply for membership of Lighthouses of Australia Inc, print out and complete
the following form, and forward by mail with payment attached to LoA Inc.
Payment must be forwarded with application for membership
to be processed. Incorporates payment authority.

Cheques must be in Australian Dollars

 PERSONAL DETAILS

*Title:

First Name:
Last Name:
Address:
City: State/Province:

Postal Code:

Telephone:

Country:

Mobile:

Email Address:

 HELPING LIGHTHOUSES OF AUSTRALIA INC
I would like to assist LoA Inc. by: Writing lighthouse news & features
Archiving of data
Creating lighthouse pages
Raising funds
My Home Lighthouse 		Organising in my local area/state
Search engine registrations
Finding and fixing broken links
General assistance
Other

Adopt a Home Lighthouse:

(Name of Australian Lighthouse)

 BULLETIN
*I wish to receive the
Monthly Bulletin by email:		 No Yes Already subscribed     (Must include email address above)
 MEMBERSHIP CATEGORY & FEES

** Membership I am interested in:
 (** Please note that the Lighthouses of Australia Inc membership year is
from 1 July to 30 June)

Individual $45 (AUD)
Pensioner $30 (AUD)
Family/Household $90 (AUD) 		Non-profit organisation $90 (AUD)
Small Business $150 (AUD)
Corporate (negotiable)

A$

Overseas membership:

Overseas add $20 (AUD) to fee selected above

B$

Concession No:

 

I also wish to make a donation:

Donation C$

Payment type:

Credit card (details below) Cheque (made payable to Lighthouses of Australia Inc) Cash

Credit card type:

Visa Mastercard Bankcard

Card Number:

 

Name on card:

  

Card expiry date:

/  

Total Amount ($ AUD):

Total A, B and C (Membership fee, overseas amount & donation)

$