Membership of RUSI South Australia
Application for Membership
I hereby apply for membership of The Royal United
Services Institute of South Australia
| Title or Rank ................. Surname .......................................... | |
| Given Names ........................................................................ | |
| Post Nominals ....................................................................... | |
| Date of Birth ......./......./......./ | |
Interest in the RUSI is from service with: - Navy |
|
Present status: - Active |
|
| Home Address ...................................................................... | |
| .....................................................Postcode ......................... | |
Ph ................................. |
Fax ................................... |
Mobile .................................................................................. |
|
| E-mail .................................................................................. | |
| Business Address .................................................................. | |
| .....................................................Postcode ......................... | |
Ph ................................. |
Fax ................................... |
Mobile .................................................................................. |
|
| E-mail .................................................................................. | |
| Post Nominals ...................................................................... | |
Preferred Contact - Home |
|
| No. & Street .......................................................................... | |
Signature......................................... Date ......./......./......./ |
|
Ph (H) ..................................... |
Ph (W)........................... |
| Nomination | |
| Proposer ......................................... Date ......./......./......./ | |
| Seconder ......................................... Date ......./......./......./ | |
Annual Subscription: $35.00 pa
Nomination Fee: $10.00
Telephone: (08) 8305 6378
Fax: (08) 8305 6378
Address: Building 160
Keswick Barracks
KESWICK SA 5035