Cheques should be made payable to 'Organ Historical Trust of Australia'
Payment may also be made via Bankcard, Mastercard or Visa credit card accounts.
- Ordinary membership $48.00
- Overseas membership (airmail) $60.00
- Family membership $60.00
- Student* / pensioner membership $30.00
- Life Membership $1,000.00
* only available for full-time students under the age of 25
SPECIAL SUBSCRIPTION LEVELS
Benefactor $500
Sponsor $300
Corporate (for companies) $250
Sustaining Member $100
NAME_________________________________________________
ADDRESS______________________________________________
___________________________________STATE______________
POSTCODE__________ TELEPHONE______________________
Email__________________________________________________
Payment: subscription $___________________________________
donation (trust fund)* $___________________________________
donation (scholarship)* $__________________________________
TOTAL $______________________________________________
* donations over $2.00 are tax-deductible and receipts will be issued
BANKCARD/VISA/MASTERCARD NO:
Please print clearly and check before sending
|____|____|____|____| - |____|____|____|____| - |____|____|____|____| - |____|____|____|____|
Signature___________________________________________________
Name on card _______________________________________________
Expires________/_______
Remittances, accompanied by this form, should be sent to:
Membership Secretary
Organ Historical Trust of Australia
Mr Pastor de Lasala
PO Box 121
BALGOWLAH NSW 2093
AUSTRALIA