EmailMe Form - Contact Form

MEMBERSHIP

SEMBA Membership $40 (Renewable in April annually)

Joining in October – December the fee is $30.00.
Joining in January – March the fee is $50.00 and includes next year’s membership. SEMBA

SEMBA is a self-help support group run by volunteer families that has been running for 37 YEARS! We can only support you if you support us. Either through membership, contribution of stories and information, attending social functions, or volunteering a small amount of your time for those in need of a friendly face.

Please enter the form details as well as payment to the Treasurer for your membership of SEMBA.

Name *

Partner

Address *

Suburb *

Postcode *

Local Council Area

Phone Number

Mobile Number

Email (ONLY way to receive monthly newsletter)

Due date (if applicable)

DD / MM / YYYY

FAMILY DETAILS: (for birthday pages of “Talking Multiples” Newsletter)

Multiples Names

Date of Birth

DD / MM / YYYY

Siblings Name

Date of Birth

DD / MM / YYYY

Siblings Name

Date of Birth

DD / MM / YYYY

Siblings Name

Date of Birth

DD / MM / YYYY

PRIVACY ACT: consent to any information or photos relating to the birth of my multiples or any other member of my family being published in the SEMBA newsletter, “Talking Multiples”. *

I Do

I Do not

HOME VISITOR: consent to being contacted by a committee member to possibly perform a home visit to a new mum living close by. *

I Do

I Do not

CONSTITUTION: I agree to abide by the constitution of AMBA. A copy of the constitution is available from the membership secretary
upon request.

What’s important to you as a member?

Any other suggestions?

How did you hear about Semba?

Payment of membership may be made by cheque or money order, cash provided to a Committee member at a SEMBA function (playgroup, meeting, etc.), or by electronic transfer (or direct deposit) to the SEMBA bank account. Payments should be sent to:

Treasurer
SEMBA (VIC) Inc
PO Box 803
Moorabbin, VIC 3189

SEMBA Bank Details:

Account name: SEMBA
Bank: Bendigo Bank
BSB: 633 000
Account Number: 135760312.
Banking Reference: Your SURNAME.

Do you intend to pay via electronic transfer? *

Yes - will do so soon

No - I will pay a committee member at a SEMBA meeting

Verification

To avoid automatic spam - please enter the following words in the space below before submitting the form

MEMBERSHIP

FAMILY DETAILS: (for birthday pages of “Talking Multiples” Newsletter)

CONSTITUTION: I agree to abide by the constitution of AMBA. A copy of the constitution is available from the membership secretary upon request.

Payment of membership may be made by cheque or money order, cash provided to a Committee member at a SEMBA function (playgroup, meeting, etc.), or by electronic transfer (or direct deposit) to the SEMBA bank account. Payments should be sent to:

SEMBA Bank Details:

Verification

CONSTITUTION: I agree to abide by the constitution of AMBA. A copy of the constitution is available from the membership secretary
upon request.