
Send
Applications to: PO Box 268 Mt Hawthorn WA 6016
Email:
PST@clubshare.com.au - Fax:
(08) 9242 2997- Phone:
(08) 9242 2996
MEMBERSHIP
APPLICATION
TYPES
OF MEMBERSHIPS AVAILABLE
ON THIS APPLICATION FORM:
I-INDIVIDUAL
MEMBERSHIP COST $89.80 pa (inc GST).
G-GROUP
MEMBERSHIP $395.00
PA (Inc GST), includes 10 PST cards
and 50 Red Clubmate Cards
Additional PST Cards at $3.95 per card per month (inc GST) includes
5 Red Club-Mate Cards.
**Please give two additional contacts for group memberships.
All memberships are for a minimum
period of 12 months.
INDICATE
TYPE OF MEMBERSHIP: INDIVIDUAL______GROUP______
IF GROUP MEMBERSHIP PLEASE INDICATE TYPE OF GROUP:
COMPANY SOCIAL CLUB _____ MEMBERSHIP ORGANISATION _____ BUSINESS_____
SPECIAL INTEREST GROUP_____OTHER_____
FAMILY
NAME____________________GIVEN NAME____________________TITLE___
FIRST CONTACT
DATE
OF BIRTH IF INDIVIDUAL MEMBERSHIP________Email____________________
FAMILY NAME____________________GIVEN NAME____________________TITLE___
SECOND CONTACT
FAMILY NAME____________________GIVEN NAME____________________TITLE___
THIRD CONTACT
NAME
OF CLUB/BUSINESS/GROUP__________________________________________
ADDRESS_______________________________________________P/C____________
PHONE______________FAX_______________Email___________________________
DECLARATION:
I agree to pay all membership fees when they fall due and give
30 days written notice if not renewing my membership as the authorised
signatory
for a group. I agree on behalf of my group or those entitled to use my
membership,
not to hold Perth Social Times responsible for the quality or conditions
affecting any
product or service offered by its agents.
Signed_________________________________________________Date___________
PAYMENT
DETAILS:
CHEQUE____MONEY ORDER____CREDIT CARD____AMOUNT ENCLOSED $__________
Please
note there is a 4% handling fee added to all credit card transactions.
TYPE
OF CARD_______________AMOUNT
$___________EXPIRY DATE ______/_____
NAME
ON CARD_________________________________________________________
CREDIT
CARD
No___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___
PLEASE
LIST ALL MEMBERS JOINING AS GROUP ON MEMBERSHIP LIST
CLICK
HERE FOR MEMBERSHIP LIST
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