*      My annual membership fee of  $18.20 will be sent by cheque Yes or No Yes No

                               OR

*      I have completed the ‘Authority to Deduct’ from my -- Select Account Method Police Superannuation Police Credit Union

My particulars are as follows:

1. What type of membership do you require?
    
2. -- Select Type -- Full Membership Associate Membership Social Membership
    
3. Please provide us with the following information so we can process your request:

First Name:  

Last Name:   

Address:       

Suburb:        

State:          NSW QLD VIC SA WA NT TAS

Postcode:     

Phone:             

Fax:                 

Mobile:             

Date of Birth:  

E-mail:             

Occupation:    

Partner            

Todays Date: