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

This form is for people who are not eligible for ADF or Protectors discounted membership, and who wish to apply for Defcom Membership. Complete your details and print the form below as a PDF. Then email info@defcom.com.au and attach the PDF with payment details. Membership is processed quickly with member number provided by email awaiting card issue.

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
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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