Membership Form | Friends of Port Willunga Inc.

Membership Form 2021

THE FRIENDS OF PORT WILLUNGA INCORPORATED
PO BOX 1138, ALDINGA BEACH 5173
INCORPORATION NUMBER A36490

Membership - $10 for singles and $20 for couples.
For residents, property owners and others who care about the future of Port Willunga.
For Existing Members, we have your information on file, please enter anything you wish to update.

Name/s*
First Last
Partner Name (if different last name)
Email (for Member correspondence)*
Enter Email Confirm Email
Email 2
Phone (land or mobile)*
Phone 2
Mobile
Port Willunga Address (if applicable, for Full Membership)
Street Address
Postal Address (if different from above)
Membership Type*
- Full Membership
- Associate Membership
Full Membership (for residents and property owners within Port Willunga)
Associate Membership (for those who care about Port Willunga, but live outside the suburb)
Membership - Single
Price: $ 10.00 Quantity:
Membership - Couple
Price: $ 20.00 Quantity:
Donation
Total
$ 0.00
Payment Method*
- Credit Card
- Direct Deposit
- Cheque
Credit Card - processed securely via Stripe. No card details stay on our website.
Direct Deposit - BSB #633-108 Account #129417291 Bendigo Bank, Aldinga Beach (full name as reference)
Cheques - payable to 'The Friends of Port Willunga Inc.' - PO Box 1138, Aldinga Beach 5173.
Payment details will email to you after submitting this form.
Credit Card

Card Details

Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

Membership Form 2021

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