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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