ORRCA MEMBERSHIP APPLICATION

Complete the form below or join online at www.orrca.org.au

You can elect to receive all correspondence by conventional mail

(standard rate) or via the internet (reduced rate.) If you choose the

internet option you must provide an email address

Membership Rates (12 months) Please tick one option

Standard Rate (incl. GST) Reduced Rate

□Individual □ $39:00 □ $28:00

□ Family □ $49:00 □ $38:00

(persons living at the same address; one family member will be

designated as the voting member and will receive all

correspondence. All family members ages 15 yrs or over may

apply to attend Rescue Training Workshops.

□ Senior □ $17:00 (no further discount)

□ Group □ $77:00 □ $55:00

Schools, community groups and other non-profit organisations.

Not eligible for Rescue Teams.)

□ Overseas □ $60:00 □ $35:00

I would like to make a donation to ORRCA of $ ……………………

Name: ………………………………………………………………..

Address: ……………………………………………………………... …………………………………………..Postcode ………. Phone: home ( ) ……………………

work ( ) …………………… mobile ( ) ………….. email ……………………………….

Date of birth: -----/-----/----- Occupation: …………………………

Payment: cheque/money order for $ payable to ORRCA Inc.

□ Visa □ Mastercard

Card Number ………………………………………Expiry ------/------

Name of Cardholder (please print) ……………………………………

Signature of Applicant ……………………………Date----/----/----

Please mail this form with your payment to:

ORRCA Inc. PO Box 315 Gosford 2250

ORRCA Inc. is registered under the Associations Incorporation Act (NSW)