Uniya - Membership Subscription Form

Tick ONE:

[_] $30 New Membership (Newsletter and 6 Briefing Papers)

[_] $25 Membership Renewal

- - - - - Membership Details - - - - - For a $5 joining fee and an annual subscription of $25, you are invited to become a member of Uniya. Members receive our Briefing Papers (six per year) as well as the quarterly Newsletter. The Briefing Papers each offer an up-to-date 4 page account of a contemporary justice and development issue. Members also assist substantially in the development of Uniya.

[_] $10 Subscriber (Newsletter only)

- - - - - Subscriber Details - - - - - $10 a year makes you a newsletter subscriber, receiving four issues a year. Your subscription assists our work, while the Newsletter keeps you in touch with Uniya's activities and provides current information about social justice matters in Australia and abroad.

TITLE: (eg Mr, Mrs, Ms) _______ FIRST NAME: _____________________________

SURNAME: ___________________________________

ADDRESS: _____________________________________________________

________________________________ STATE: _______ POSTCODE: __________

I enclose a cheque/money order (made out to "Uniya") for $ _______

- OR -

Please debit my Credit Card

[please circle one] Mastercard Bankcard Visacard

Card Number: ________ : ________ : ________ : ________

Expiry Date: __________ Signature: ____________________________