Membership Application and Donor Authorisation Options

Once this form is submitted, we will confirm your information before final submission for processing. We can only accept credit card transactions of $10.00 and over. If less than $10.00 you can send a cheque or money order.

If you have any questions, or prefer to place your order via the phone, you can reach us on 1800 880 190. If you wish, you can fax this order with your credit card details on 02 9826 1777. Or mail a cheque/Money order to Animal Welfare League NSW, 1605 Elizabeth Drive, Kemps Creek NSW 2178.

Thank you for your support.

Required fields are marked *

 
Donations (All donations are GST Exempt)
I would like to donate $
 
Membership Type (Includes GST)
     
Life Member (payable only once)
$250.00
each
Senior Member (concession card holder)
$5.00
 each
Ordinary Membership
$20.00
 each
Junior Member (under 16 years)
$5.00
 each
 
Total $
 
Do you wish your Membership to be affiliated with : *

Your Local Branch Ingleside Shelter West Hoxton Shelter
 
Enter Personal Details Below
 
First Name * Last Name *
Address *    
City * State * Postal Code *
Country *    
   
Home Phone: * Work Phone:  
 
E-Mail Address * (required)    
 
 
Postal Address
 
 Check if postal address is the same as the address above.
   
First Name * Last Name *
Address *    
City * State * Postal Code *
Country *    
   
 
Payment Information
 

Card Type (Please choose one) *
Master Card Visa  
 
Card Holders' Name *
   
Card Number *(Please do not use spaces or hyphens) Expires * (use format mm/yy)
 
Additional Instructions or comments


Please check your form and make any changes now, before it is processed. Once submitted, we will confirm your information via email. We can only accept credit card transactions of $10.00 and over. If less than $10.00 you can send a cheque or money order.
This form uses SSL encryption to ensure the safety of your information.


If you have any questions, or prefer to place your order via the phone, you can reach us on 1800 880 190. If you wish, you can fax this order with your credit card details on 02 9826 1777. Or mail a cheque/Money order to Animal Welfare League NSW, 1605 Elizabeth Drive, Kemps Creek NSW 2178.


Thank you for your support.