Associate Membership Application Form - MAIL OR SCAN/EMAIL to info@defcom.com.au

This form is specifically designed for people who are not eligible for free membership and who wish to apply for Defcom Protectors Associate Membership. Complete your details and then print the form below before returning to DEFCOM with your credit card details, cheque or money order to DEFCOM MEMBERSHIP PO Box 4333 Forest Lake 4078. Please allow up to 21 days for delivery.

Personal Details
Title	Select Miss Mrs Ms Mr Dr
Initials
Surname
Postal Address
Town
Postcode
Contact Phone	(if landline please include the area code)
Email
Associate Categories and Fees
Type of Associate	Select Associate Category ________________________________________ SPECIAL 5 YEAR MEMBERHIP OFFER TPI Recipient Spouse/Partner of current FREE member Other member of the public
Annual Fee	$50.00 (inc. GST) SPECIAL 5 YEAR MEMBERSHIP OFFER FOR ANY CATEGORY
	$28.50 (inc. GST) ONE YEAR for Other member of the public
	$12.00 (inc. GST) ONE YEAR for TPI Recipient OR Spouse/Partner of current FREE member
Payment Details
Payment Method	Select your payment method MasterCard Visa Card PayID
Credit Card No	Please debit the annual fee to my credit card
Expiry Date
Cardholders Name
or PayID	info@defcom.com.au (note shows as Holidays Direct, DEFCOM's travel company)
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