EmailMe Form - M'ship: Graduate Upgrade to Full

AEU Member Number

Date of Birth

DD / MM / YYYY

Title

Mr / Ms / Miss / Mrs

Name *

First Middle Last

Postal Address

Suburb

State

Postcode

Home Address

Suburb

State

Postcode

Home Phone

Mobile Number

Personal Email

Aboriginal or Torres Strait Islanders

I am of Australian Aboriginal and/or Torres Strait Islander descent and wish to be identified as such on our records.

The AEU Journal is available online at: www.aeusa.asn.au

I would prefer to receive a printed copy

EMPLOYMENT DETAILS

I am... *

a Permanent teacher

a Contract teacher

a TRT

Unemployed

Workplace *

Campus/Work Group

(if applicable)

Employee ID No.

Fraction of Time *

Work Email

Preferred Email

Personal

Work

Contract Dates *

Start
End

PAYMENT OPTIONS

*All fields containing account or card information are encrypted*

I wish to pay by... *

Direct Debit

The amount drawn from your account each fortnight is based on your employment details and membership subscription rates as set by AEU Branch Council and published on the AEU Website. The amount will vary when new subscription rates are set or your salary changes. If you are unsure of the amount payable or the date deductions are drawn, please contact us.

DIRECT DEBIT REQUEST
I request and authorise Fat Zebra ACN 154 014 785, APCA User ID Number 502574 to arrange, through its own financial institution, a debit to the nominated account below any amount the Australian Education Union SA Branch has deemed payable.

By signing this Direct Debit Request, you have understood and agreed to the terms and conditions governing the debit arrangements set out in this Request and in your Direct Debit Request Service Agreement.

Financial Institution Name

Financial Institution Address

Title of Account: (Name/s of account holder/s) *

BSB *

xxx-xxx

Account Number *

Signature *

Clear

Use your mouse to sign in the box above by clicking and holding (you may need to click once to activate the field)

Automatic Payment by Credit Card

I authorise the Australian Education Union (SA Branch) to make deductions of my AEU subscription from my credit card as per below.

Please debit my card *

Monthly

Quarterly

Half-Yearly

Card Type *

Visa

Mastercard

Cardholder's Name *

Credit Card Number *

xxxx-xxxx-xxxx-xxxx

Expiry Date *

MM/YYYY

I hereby update my status as a member of the Australian Education Union (SA Branch) and agree to abide by the Rules of the union. I agree to pay fees owing in accordance with the union's schedule of subscriptions. Member information is collected and held by the AEU only for the purpose of achieving the objectives of the Union and providing services and benefits to members. I agree to the union disclosing personal information to other organisations in accordance with the AEU's Privacy Policy.

I understand that the union's rules require me to give written notice of resignation.

Please note that assistance, legal or otherwise, cannot be provided for issues that occurred prior to becoming a member of the AEU SA Branch.