Mr/Mrs/Miss .................................................................................

Address     ....................................................................................

Employer  ....................................................................................

Address    ....................................................................................

Spouse/Partner Name .......................................................................

Name and date of birth of Children under 16 years of age

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I work as a ........................................................... for ..........hrs per week

How do you want to pay Union fees? (cross the others out)

I authorise my employer to deduct fees from my wages and send them to the Union

I want to make monthly automatic payments from my bank account

Send me a bill and I will pay 3/6/12 monthly

I have read the conditions of membership application, have understood it and accept it