Manning Clark House 2018 membership form

New Membership Form 2018-2rev

 

Thank you for generous patronage as a financial member of Manning Clark House!

To become a member,  renew your membership or update your current contact details, please complete the information requested below, marking your email or envelope ‘membership.’ Print this page and then email it to manningclarkhse@gmail.com Alternatively, post the completed form to: The Treasurer, Manning Clark House, PO Box 3096, Manuka ACT 2603.

Date submitted:

Name:

Address:

Telephone nos:

Email:

Interest in volunteering? (List skills and/or contact volunteer coordinator Fleur Millar on 0421 187 688.

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Membership fees (tick relevant box). Members receive concessions at events.

 Are you renewing your membership? Are you a new member? (Circle one)

  • Individual member/couple 12 months – $80 couple, $50 single
  • Recipients of government income support, full-time students/couples where both are in this category 12 months – $50 couple, $35 single
  • Corporate rate $100/ organisational rate – $50

Manning Clark House Inc. is registered as a charity with the Australian Charities and Not-for-Profits Commission ABN 39 997 015 544. Donations over $2 are tax deductible.

Donation to Manning Clark House Inc – please indicate $…………………………..

Payment options (preferred payment is by credit card or direct bank deposit) or you can post a cheque.

Card type:

Card number:

Expiry date (month and year):

Name on card:

Amount to be debited:

Signature and date :

You can deposit directly online into the MCH Westpac bank account in Manuka in the following way:

ACCOUNT NAME: Manning Clark House

BSB: 032 729 ACCOUNT NUMBER: 167805

TRANSFER DESCRIPTION: Mem XXXXX (1st 4 letters of surname + initial) or if includes donation: MemD XXXXX   Please tell us the DATE OF TRANSFER: dd/mm / yyyy

If you wish to, please write (or attach) a short statement about the kinds of activities you would like to see MCH conduct in the future.

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