Membership Application/Renewal Form

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Please provide the completed application form to the Treasurer in person or by post with appropriate payment.
Treasurer – Vipen Dogra, 2 Glencoe Avenue, Chatswood, NSW 2067.

Payment may made by Cash or Cheque payable to ‘Australian Hindi Indian Association’  or deposit to the AHIA Bank Account.
For direct deposit include your name and text ‘NEW’ or ‘RENEW’as appropriate in the deposit slip.
Bank Details - Bank: National Australian Bank, Name – Australian Hindi Indian Association,   BSB No: 082330,  Account No: 534859215.
 

                Category and Term of Membership (Please circle or tick the amount based on the membership category and term)

 

Regular (Up to 59 years)

Senior (60 years and over)

Life

$200

$150

Annual (New)

$25

$20

Annual (Renewal)
Late Fee for renewal after end of Sept.

$25
$5

$20

$5

 

Applicant/s  and Spouse Details:
The form can be used for one i.e. individual or two i.e. husband/wife memberships.   Spouse details are optional  for individual  membership.
Items marked with astricts  (*) are essential.   For renewals other details are required only if they have changed.
Use capital letters.

 

Applicant 1

Applicant 2 or Spouse

Title

Mr/Mrs/Ms/Dr.

Mr/Mrs/Ms/Dr.

Given Name *

 

 

 

Family Name *

 

 

 

Phone No.

(Landline)

 

 

 

Mobile Phone No.

 

 

 

Email Address *

 

 

 

 

Date of Birth

 

 

 

Wedding Date

 

 

Postal Address

 

 

 

I/We wish to enrol as member/s /renew membership (strike out as appropriate) of the Australian Hindi-Indian Association Inc. (AHIA) in the above-mentioned category.   I shall abide by the Constitution, and rules and regulations of the Association.   I authorise AHIA to maintain the details provided above.

                Note:   1.   All AHIA Correspondence is by your above email address only.

                               2.    AHIA Membership is subject to approval by the Executive Committee.  Membership fee paid will be refunded if membership is  not approved.
 

                Signature of Applicant  1:   .................................Applicant 2 ...............................                     Date:  ....................

                Proposer Details (For New Members Only)

I, (Full Name)    ........................................................................................................................... being a member of AHIA,                        

 propose nomination of the applicant, who is personally known to me, for membership of the association.

                Signature of Proposer: .............................................                                 Date:  .......................

                ___________________________________________________________________________________________________________________________

                For Office Use Only:    Payment Received:    Cash (   )      Cheque    (    )          Direct Deposit   (   )               
                Receipt No.  .......................  Banked on:  ...........................Entered MYOB entry on:........................                                                                   v18.3