Membership Renewal Form

NAME & CONTACT DETAILS

First Name*

Last Name*

EMAIL ADDRESS

Has your Email Address Changed?*

No
Yes

Please advise your current email address

Email*

Please advise your new email address

Email*

Enter Email Confirm Email

PHONE NUMBERS

Have your Phone Numbers Changed?*

No
Yes

Please advise your new phone number(s)

Mobile Phone

Phone (Other)

RESIDENTIAL ADDRESS

Has your Residential Address Changed?

No
Yes

Please update your Residential Address as it has changed in the last 12 months.

Street Address*

Street Address Line 2

Suburb / Town / City*

State*

Postcode / ZIP*

Country*

POSTAL ADDRESS

Has your Postal Address Changed?

No
Yes

Please update your Postal Address as it has changed in the last 12 months.

Postal Address the same as the Residential Address?*

Yes
No

Please update your Postal Address as it has changed in the last 12 months.

Postal Address*

Postal Address Line 2

Postal Address Suburb / Town / City*

Postal Address State*

Postal Address Postcode / ZIP*

Postal Address Country*

MEMBERSHIP DETAILS & RENEWAL OPTIONS

AAC-QC Membership Number

FAI License Number (if applicable)

Select A Membership Option*

$162.00 AAC National & AAC-QLD
Full Membership
$90.00 AAC-QLD
Full Membership
$40.00 AAC-QLD
Social Membership

FINALISE MEMBERSHIP RENEWAL

Acceptance*

I AGREE

I agree I shall at all times be bound by the Memorandum & Articles of Association of the Australian Aerobatic Club (Queensland Chapter) Limited and any Rules and By-Laws which may be in effect from time to time.

Date*

Digital Signature

If you have your signature as an image file (jpg, jpeg, gif, png, or pdf) you can sign your membership renewal digitally by attaching your signature file.

DIRECT DEPOSIT BANKING DETAILS

Please direct deposit your membership renewal fees into the AAC-QLD bank account, using your surname as the reference.

Bank	Westpac Banking Corporation
Account Name	Australian Aerobatic Club (Qld Chapter) Limited
BSB	034-115
Account Number	164115
Reference	Your surname

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