Rejoin - AEU Tasmanian Branch

1. Personal Details

Name*

First Middle Last Preferred Name

Date of Birth*

Gender*

Are you of Aboriginal or Torres Strait Islander descent?*

Yes
No

Address*

Address Suburb State Postcode

Mobile number*

Home Phone

Primary email address*

Non work email address

2. Membership Type

Membership Type

Member
Relief

Primary Workplace Name*

Primary Workplace Position Name*

Employment Status at Primary Workplace

FTE at primary workplace*

Eg: 5 days per fortnight is 50, full time is 100.

Please enter a number from 1 to 100.

3. Membership Contributions Details

Leadership

Please select your payment frequency

Fortnightly
Monthly

Please select your annual salary

Please select you annual salary

Teaching

Please select your payment frequency

Fortnightly
Monthly

Please select your annual salary

Non-Teaching

Please select your payment frequency

Fortnightly
Monthly

Please select your annual salary*

Please select your annual salary

Relief

Please select your payment frequency*

Fortnightly
Monthly

All

Your total fortnightly contributions are estimated to be:

$ 0.00

Your total montly contributions are estimated to be:

$ 0.00

Payment Type

Direct Debit
Credit Card

Credit Card

Credit Card Number

Expiration Date

Year

Security Code*

Cardholders name

Direct Debit

Account Name

Branch

BSB

Account Number

4. Membership Agreement

Do you agree to the Membership Terms and Conditions?

Yes
No

Comments

This field is for validation purposes and should be left unchanged.

Rejoining AEU Membership Online Form

1. Personal Details

2. Membership Type

3. Membership Contributions Details

Leadership

Teaching

Non-Teaching

Relief

All

Credit Card

Direct Debit

4. Membership Agreement