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/ ISCAST Membership Application Form

ISCAST Membership Application Form

Submitted by philippa on Thu, 29/10/2009 - 12:47

Please fill in the details below to apply for membership with ISCAST.

Application Details

Name: *

Address: *

Suburb: *

State: *

Postcode: *

Phone: *

Fax:

Email: *

I prefer to receive information by: *

Post

Post (but please include me on your email list)

Membership

Membership is for one year from the month of joining.

I wish to become: *

an Associate of ISCAST: $50 pa

a Student member of ISCAST: $20 pa

a Family/Corporate supporter of ISCAST: $70 pa (for families, organisations, colleges, schools, churches)

Chapter: *

Vic

Tas

QLD

Bathurst/Orange

NSW

ACT

Subscription

I would like to subscribe to Science & Christian Belief (S&CB). I am:

an ISCAST member: $50 pa

a non member: $61 pa

I wish to receive S&CB in the following mode:

Printed

Electronic version

Both printed and electronic (an additional $6 will be charged)

Donation

I would like to make the following donation:

$200

$150

$100

$50

Other *

* please specify other:

Payment

No GST is included.

I will be paying by:

Cheque: Please make cheques payable to: ISCAST Limited and forward to - ISCAST, c/o Stockdale ACS, 300 Huntingdale Road, Huntingdale 3166.

EFT: BSB: 032-187 Account No.: 510786 Account name: ISCAST Limited. Please include your name in the reference and notify us of the transaction by returning this form for our records.

Credit Card: Contact the ISCAST office on 9535 7045 with your details. A credit card surcharge applies - $1 for each $50 or part thereof

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