Renewal or Change of Contact Details form

Please indicate your Type of Request: ( click one or the other button ) Renewal for a further calendar yearChange of contact details

If this a membership RENEWAL and if your membership details have NOT changed, please click in the "No Change" box and leave the unchanged sections of this form blank. This will assist our Membership Secretary.

NO CHANGE ( please click in box if applicable ): I am renewing my existing membership and my membership details have not changed since my last renewal.

First Name: (required)

Last Name: (required)

Email:

Membership class renewal: ( choose one ) Choose an option from the drop down list using the button at right >>>>Full - $40.00Senior/Concession - $25.00Student - $25.00 ( Applicant is engaged in full time studies or is an apprentice )Junior - $25.00 ( Applicant is under sixteen years of age )I am only renewing for Additional Family Members as listed below

Additional Family Members ( Optional, each- $12.00 ) - please list any additional family members to be renewed. Additional family members must reside at same address:

Show total payment due for all membership renewals requested in box below:

Please indicate your method of payment: ( choose one ) choose a payment method from the drop down list using the button at right >>>>Electronic Funds Transfer ( to Queensland Air Museum: , BSB: 633000 , Account No: 149594467 )Post ( to Queensland Air Museum, PO Box 3246, Caloundra DC , Qld 4551 )Cash to staff at QAM Front Desk

Agree- click in box at right: ( required ) All applicants agree to abide by the conditions of the QAM Constitution

Title (choose one from list ): choose a title from the drop down list using the button at right >>>>MrMr & MrsMrsMissMsMasterDrProfRev

Age ( Optional ):

Address Line 1:

Address Line 2:

Suburb:

Town:

State : Choose from drop down list >>>QLDNSWACTVICTASSAWANT

Post Code:

Country ( for membership outside of Australia please email member@qam.com.au ]:

Home phone number:

Mobile phone number:

Newsletter delivery method (choose one from list ): Email - ( preferred option if possible to help reduce cost of printing and postage expenses )Post Office Mail

Comments/Suggestions: