EmailMe Form - M'Ship: New Members

Title

Mr / Ms / Miss / Mrs

Name *

First Middle Last

Postal Address *

PO Box OR Street Number AND Name

Suburb *

State *

Postcode *

My postal and home address are the same

Home Address

Street Number AND Name

Suburb

State

Postcode

Date of Birth

DD / MM / YYYY

Gender

Female

Male

Other

Home Phone

Mobile *

Personal Email

Work Email

Preferred Email

Personal

Work

**This is the email your tax statement will be sent to**

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

As an AEU (SA Branch) member, you’re eligible to join Teachers Health. With your consent, we’ll share your contact information with Teachers Health so they can get in touch with you. Tick below if you’re happy for this to occur.

Yes, i am happy for Teachers Health to contact me

EMPLOYMENT DETAILS

Employee ID No.

Workplace *

TRTs: please write N/A

Campus/Work Group

If working at a site with multiple campuses, please indicate which campus you are based at

Employment Classification *

TEACHING CLASSIFICATION *

Salary Step *

Fraction of Time *

ANCILLARY CLASSIFICATION *

Level *

Step *

Hours/week Permanent *

Hours/week Contract *

Contract Dates *

Start
End

Annual Salary

How many terms are you employed? *

Any other relevant information:

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 this form. Click in the grey area below the yellow highlighted line and the word 'signature'. Click and hold the mouse button as you sign.

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 *

Please use a hyphen to separate as follows:
xxxx-xxxx-xxxx-xxxx

Expiry Date *

MM/YYYY

IMPORTANT INFORMATION FOR MEMBERS WISHING TO PAY BY CREDIT CARD

On receipt of your membership application we will draw any monies owing to catch you up to your nominated payment cycle listed above. Please ensure funds are available.

UNION RULES

I hereby apply for membership of the Australian Education Union (SA Branch) and agree to abide by our Branch Rules (available at aeusa.asn.au/about). 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.