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FAA Membership and Donation Form
Personal Information
Please complete all sections
Title
*
-
Mr.
Mrs.
Ms.
Dr.
Prof.
Name
*
Surname
*
Email
*
Telephone
*
Mobile Phone
*
Address
*
Membership Details
€5 Student Membership 1 year
€15 Individual Membership 1 year
€25 Family Membership 1 year *
€60 Individual Membership 5 years
€250 Individual Life Membership Life
* Family membership includes parents and children under the age of 15
Donation Details
Donation
€
Euros
.
Cents
Payment Details
I would like to pay by
Cheque: (cheques are to be made out to: FAA)
Bank Transfer: Bank of Valletta plc: Account No: 400 1851 6481
Bank Transfer: HSBC Bank Malta plc: Account No: 061-253-217-050
When paying by cheque please send payment and a print out of the Form to :: FAA, Room 83, The National Pool, Teresa Spinelli Road, Tal-Qroqq, GZR 1711, Malta ::
When paying by bank transfer it is essential that the Surname and the word ‘Membership’ is entered in the payment detail section.
Enter the cheque number or bank transfer reference number.
*
When paying by cheque please put in the cheque number, if paying by bank transfer please put in the transfer reference number.
Total Amount
€
Euros
.
Cents
I wish to help as a Volunteer
Yes
No
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