Membership Registration

This form is used to register officially as a financial member, please review the fees. Please pay your membership after you have filled in this form.

Name

First Name

Last Name

Mobile Phone

How would you like to pay your fees?

One-off payment of $460 (covering everything)

One-off payment of $250 (covering basic membership)

Monthly payment $38 (covering everything)

Monthly payment $20 (covering basic membership)

Mountain Moon Affiliate (suggested donation $5-10 per attendance)

Other arrangements made with the Treasurer

What date will you pay or start your payment?

Membership Type

Message to the treasurer

Provide any requests or additional information to the treasurer about your situation or membership.