M E M B E R S H I P - A P P L I C A T I O N - & -
T A X - I N V O I C E

ABN 31 011 021 088
Complete the details below, print out this form and return with payment enclosed to:
NSSA Membership - GPO Box 7048, Sydney NSW 2001
All rates are active from July 2002 and include GST
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Please tick one: 

    Are You are a New Member?   Renewing Member?
Your Details: Family/School applications, please include name of main contact.

First Name:

 Title: Mr/Mrs/Ms/Miss/Dr/Prof

Surname:

Address:

Suburb:

 State: P/code:

Telephone:

 Best to Call Day Evening

Mobile:

Facsimile:

email:

 Include me for email notices

website: http:// 

 If you have one
I would like to join the NSSA in the following membership category: 
Regular $50.00 pa (includes $4.55 GST)      
Visionary $200.00 pa (includes $13.64 GST)  
School $100.00 pa (includes $4.55 GST)      Teacher $70.00 pa (includes $1.82 GST)
Additional AD ASTRA Subscription $50.00 pa (GST not inclusive)
Payment Details: Chq M/Order . Credit Card: Bankcard Mastercard Visa AMEX

Cardholder's Name:

 As shown on card

Card Number:

 :::Check details carefully

Card Expiry Date:

 / Date Signed: //


Cardholder's Signature:
_______________________________ Card orders must be signed


AMEX Only:
  Four digit security number printed on face of your card 
Membership Survey Details: Providing answers is optional 

Age Group:

 0-15 16-20 21-30 31-35 36-45 46-65 65+ 

Occupation:

Hobbies:

Club Member:

 Other space-related clubs?
Office Use Only:  Mem.#: Bank: BSB: A/C:
Chq/MO#: Date Chq/MO: Amount $:
Deposit Date: Comment: