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Membership Renewal

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Personal Details

Membership No.*

Printed at the top of your renewal form.

Name*

Prefix First Last

Phone*

Address

Address Line 1 Address Line 2 Suburb State Postcode

Membership

Before renewing, the Arthritis TAS Board is offering members the option to change to a new affiliate status. Affiliate status is free for 2 years and as an affiliate you will receive the same benefits as a member, ie Arthritis Matters magazine and the opportunity to join one of our support groups. The only difference is that you will no longer have any Governance functions like attending and voting at AGMs. We hope this new option will be attractive to many of our members.

Membership Type:*

Affiliate
Free for 2 years
(AFFILIATE)

Adult
$49.50 for 1 year
(MB_R_WEB)

Adult Concession / Student
$27.50 for 1 year
(MB_R_WEB)

Family
$60.50 for 1 year
(MB_R_WEB)

Family Concession
$44.00 for 1 year
(MB_R_WEB)

Please provide your Concession or Student number here:*

Family Members to be covered by ATAS Membership*

Title

First name

Last name

Donations

As my membership is free, I would like to make a donation in the amount of:

Please enter the amount in dollars (eg. 10)

I would also like to make a donation in the amount of:

Please enter the amount in dollars (eg. 10)

Payment Details

Total

Credit Card

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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ATAS Support Groups

I agree to that my details may be provided to Arthritis TAS Support Groups in my area

Like-minded organisations

Occasionally, we may allow like-minded organisations to contact you with information that may be of interest. They may allow us to do the same so we can reach more people with vital information. Please tick here if you do NOT want to receive communications from organisations we trust.

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