Renew Membership

To begin your renewal please fill out the below.

I hereby apply to be renewed as a Service Member of the League and a member of the following Sub-Branch
Sub-Branch to renew*

Personal Details
Name*
Prefix First Middle Last
Nee (Maiden Name):
Date of Birth*
Date Format: DD slash MM slash YYYY
Mail Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Work Phone (inc STD)
Home Phone (inc STD)
Mobile*
Email*
Previous Membership Details
Service Number*

Membership Subscription
Membership
Membership*
- 1 Year Subscription
- 3 Year Subscription
- 5 Year Subscription
Would you like to include a donation?
Total
$ 0.00
Credit Card
American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Declaration and Agreement
*
- I declare that I have not been convicted of a criminal offence and do not have charges outstanding pertaining to a criminal offence.
*
- My application details are true and correct.
*
- I agree to uphold the Constitution of the League and its By-Laws.
We will not use any of the information on this membership form without your specific permission in writing, other than to record you as a member of the League and will not pass that information to anyone outside the League. As per By-Law 12.

Annual membership $40.00 is required with this form if payment before 30 June.

Pro-rata payments apply after 30 June.
July-September $20.00
Oct-Dec $40.00 - covers following year
Signature*
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Phone
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Personal Details