Affiliate Membership Application Please fill in each field below to apply for your membership. Your Name Your Address Your Post Code Your Phone Number Your Date of Birth (Day/Month/Year) Your Email Address Are you a previous Affiliate Member? No Yes Verify Qualification Details I claim qualification in one of the following categories (select one only) SpouseChildStep-ChildSon-in-lawDaughter-in-lawParentSister, Brother or CousinGrandchildNephew, Niece, Aunt or UncleBrother-in-lawSister-in-lawPersons awarded the Certificate of Merit or a certificate of Appreciation from the RSLPoliceAmbulanceFire BrigadeState Emergency Service Full name of person who is a Service or Life Member or Life Member (Include Sub-branch name) or a person who at the time of death was eligible in respect of the above claim (provide service details) Sub-branch (if applicable) Service details (if applicable) HQ Membership Number (if applicable) TO THE STATE SECRETARY Application is hereby made for the issue of an Affiliate Member's badge and I understand that the bade is not transferable and will be given up should I cease to be a financial Affiliate Member of an Rsl Sub-branch. I hereby apply for Affiliate membership of the Prahran Sub-Brach and duly declare that I will abide by the Rules of the said Sub-Branch in this respect. By ticking the 'Yes' box below I acknowledge this represents my consent to apply for the Affiliate Membership. Yes, I agree No, I do not want a membership Price of membership: $25 (paid annually) [paypalsubmit id:PaywithPayPal email:email@example.com currency:AUD itemamount:membership-price itemname:your-name quantity:quantity return_url:https://prahranrsl.com.au/membership-success/ cancel_url:https://prahranrsl.com.au/payment-not-successful/ "Pay with PayPal"] You can pay using your PayPal account or via a credit card. Privacy statement We will not use any of the information on this membership form without your specific permission in writing, other than to record you as a member of the League and we will not pass that information to anyone outside of the League.