Membership Application Form Member Sign Up 2021 - 2022 Is this a new membership or a renewal?* New Membership Membership Renewal Youth Membership (16 - 30 yrs) Student Membership Please select membership type. 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From time to time there are projects where assistance from members may be sought. Do you have any skills or talents that you could volunteer to help AWiA? Please give an indication of your capabilities and what you would be willing to contribute?*I authorise AWiA to send me regular communications, including a fortnightly Members Update and quarterly newsletter, The Buzz, plus any other official publications.* Accept I authorise the inclusion of my personal details on a membership list for distribution to other members. I understand that this list is the property of AWiA and is for members’ personal networking use only.* Accept Exclude me I understand I may be photographed or filmed by AWiA and that the recorded image/film/audio may be used on social media, in advertisements and other publications or through news outlets (television, social, radio, paper, magazine) only in relation to Australian Women in Agriculture. Is this acceptable?* Accept Exclude me I understand that in the event that the company is unable to meet its debts and it is wound up, then I will contribute $5 towards that debt.* Accept As per Article 6 - Winding Up in Australian Women in Agriculture Memorandum of Association Membership Fee* 1st July 2021 - 30th June 2022 $90.00 (GST inc) Please contact AWiA Treasurer, Sarah Parker on 0418 883 250 or email treasurer@awia.org.au if you require a student or youth membership. Educational Institution* Student Number* Student Number is Required for Student MembershipThe Buzz Newsletter Postage and Printing If you do not have access to email, please tick the box above to receive 4 x quarterly editions of The Buzz posted to you. Email is preferable in consideration for the environment however, we understand that internet capacity and capability may be limited in some regions.Donations Accepted Please note that donations are not tax deductible at this stage. Payment Options* Credit Card — Pay Now Direct Debit Cheque There is an additional 1.7% fee for credit card payments.Credit Card Fee Price: $ 0.00 Total $ 0.00 Westpac BSB: 035 621 Account number: 193 909. Use your full name as Reference. Email receipt to treasurer@awia.org.au Make Cheque out to Australian Women in Agriculture Post Cheque to PO Box 7387 Shepparton, VIC, 3632 Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Receipt Receipt Required Please note: A receipt for membership will not be issued until payment is received. Your membership may be tax deductible.For all enquiries, email AWiA Treasurer Sarah Parker at treasurer@awia.org.au or phone 0418 883 250.Post Body