Please enrol me as a member of the PTUA.
* indicates mandatory field.
| Title | |
| Given name * | |
| Family name * | |
| Organisation | |
| Address * | |
| Suburb/town * | |
| State * | |
| Postcode * | |
| Telephone * | (Home) (Work) (Mobile) |
| Email * | |
| How did you hear about the PTUA? | |
| Select membership type * | ||
| 1 year | 2 years | |
| Bronze (Regular) | $25 | $40 |
| Silver (Donor) | $50 | $80 |
| Gold | $100 | $175 |
| Family / Household / Community Org. | $50 | $80 |
| Concession | $12 | $20 |
| Corporate | $500 | n/a |
| I would also like to make a donation: | $ | |