Membership Application/Renewal

The Annual Membership fee for Save our State is $10.00.
There is no joining fee.

Personal Information

First Name: .................................Last Name:....................................

Business/Company/Organisation: .....................................................

Position: .............................................................................................<

ABN: ..............................................................

Address: ............................................................................................<

Suburb: ..............................State: .......... Post Code:.........................<

Postal Address (if different): ......................................................................................<

Suburb: ..............................State: ,,,,,,,,,Post Code:.........................

Phone: ( )....................... Fax: ( ) .......................

Mobile: .................................................

Email: ...................................................


Payment Method

Please indicate which payment method you wish to use,

Electronic Funds Transfer
BSB:  105-900
Account number: 158593540
Reference Number: This is supplied by your bank on the Internet Banking receipt
and will be used to track the payment for your membership.

Cheque
Please make cheques payable to Save our State South Australia and post with this completed form to The Membership Officer, SOS-SA