Electronic Frontiers Australia Inc.
PO Box 382, North Adelaide, SA 5006
Tel: 02 9011 1088
www.efa.org.au
ABN: 35 050 159 188
MEMBERSHIP APPLICATION / RENEWAL FORM
(for mailed applications)
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Date: ___/___/___
I wish to:
[ ] submit a NEW application for membership of EFA
[ ] RENEW my existing EFA membership
I support the Objects and Purposes of EFA and agree to be bound by the
EFA Rules of Incorporation. I enclose payment for:
[ ] Individual Membership
$55 per year. Fees are due on 1 July each year and pro-rata
fees apply to those joining during the year. Please tick (or
insert *) to indicate the amount you are paying:
[ ] $55.00 - if paid during April to September inclusive
(current to 30 June in the following year)
[ ] $41.25 - if paid during October to December inclusive
[ ] $27.50 - if paid during January to March inclusive
[ ] Life Membership
$275 A once-only fee; category open to individuals only[1].
[ ] Associate Membership
$825 or $0.275 per member per year, whichever is the greater[1].
This category is open to unincorporated or non-profit
organisations, bodies corporate or business partnerships and
confers membership upon the member entity, not on multiple
individuals within that entity. Fees are due on 1 July each
year and pro-rata fees apply to those joining during the year.
_______ Number of members of entity applying for membership.
Pro-rata fees (please insert the amount you are paying):
$______ If paid during April to September inclusive (current
to 30 June in the following year): Annual membership
fee, i.e. $330 or $0.11 per member per year, whichever
is the greater.
$______ If paid during October to December inclusive: 75% of
annual membership fee.
$______ If paid during January to March inclusive: 50% of
annual membership fee.
If you are not sure of the applicable amount, please ask our
Membership Co-ordinator:
Note:
1. EFA is not required to levy GST on membership fees.
________________________________________________________________________
DONATION:
[ ] I wish to make a donation of
$________ to further support the activities of EFA. (Donations are
not tax deductible because Australian tax law does not
allow advocacy and lobbying organisations to be
deductible gift recipients.)
________________________________________________________________________
PAYMENT METHOD:
[ ] Cheque or Money Order (payable to Electronic Frontiers Australia Inc.)
[ ] Credit Card (Visa or Mastercard)
Amount: $___________
Credit Card No. ______________________________ Expiry Date: ___/___
Important: Please re-check that the number and date entered above is correct.
Name on Card: ____________________________________________________
Signature of Cardholder:____________________________________________
________________________________________________________________________
YOUR CONTACT DETAILS (Required fields are marked *):
Title: _____ (Mr Mrs Ms Dr etc)
*First Name: ____________________ *Last Name: _____________________
*Email #1: _______________________
If you are RENEWING your membership and your email address has changed
and EFA has not been advised, please enter your old email address below
(to ensure your renewal payment is applied to your membership, not
someone else's with the same name):
Old Email: _______________________
Email #2: _______________________
Organisation (*only if Associate Member):________________________________
*Street or PO Box: ________________________________
*Suburb: ________________________________
*State ________ *Postcode ________ Country ______________
Work Phone: (___)________________ Home Phone: (___)________________
Facsimile: (___)________________ Mobile Phone: _____________________
________________________________________________________________________
SUBSCRIBE TO EFA MEMBERS' MAIL LIST:
[Note: This section only applies to NEW membership applications].
The EFA Members' Mail List is a low volume announcement list, not
a discussion list, and only EFA Board members can send email
messages to the list. This list is used to inform members of
membership matters (eg. date/details of Annual General Meeting)
and to send EFA newsletters and EFA announcements/alerts to
members.
*Subscribe to the EFA Members' Mail List?
[ ] Yes [ ] No
________________________________________________________________________
YOUR INTERESTS (Optional):
Electronic Frontiers Australia Inc. is run by volunteers. Are you
willing to assist? [ ] Yes [ ] No
I am particularly interested in the following issues:
[ ] Net Regulation [ ] Censorship [ ] Privacy
[ ] Crypto [ ] Intellectual Property
Other Interests:
_
_
I have the following expertise I'd like EFA to know about:
_
_
_
________________________________________________________________________
Other Info (Optional):
We would be interested to know where/how you heard about EFA, if you
would like to tell us:
_
Comments if any:
_
_
_
_
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Please print out this form, preferably in monospaced
non-proportional) font, and mail with payment (cheque or
Australia Post Money Order) to:
Membership Coordinator
Electronic Frontiers Australia Inc
PO Box 382
NORTH ADELAIDE SA 5006
or credit card payments may be sent by:
PGP-encrypted email to:
using the EFA PGP public key.
(EFA does not recommend passing unencrypted credit card details via email.)
You can also pay your membership using EFA's online secure payment
New Membership Application Form or Membership Renewal Form.
________________________________________________________________________
PRIVACY POLICY:
Electronic Frontiers Australia Inc. is a voluntary non-profit
organisation dedicated to the preservation of online civil
liberties and online privacy. EFA's Privacy Policy is available at:
http://www.efa.org.au/about/privacy-policy/
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Electronic Frontiers Australia Inc. is incorporated under the South
Australian Incorporated Associations Act.
9 Feb 2008 www.efa.org.au/JoinEFA/membform2.html Version 6.9
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