MEMBERSHIP FORM FOR RMA

TYPE OF MEMBERSHIP
Select OptionFamily membership / year - $120Individual membership / year - $75Student / year - $50
NAME

FAMILY NAME

DATE OF BIRTH

SPOUSE NAME

CHILDREN NAME

EMAIL

PHONE

MOBILE

ADDRESS
HOUSE/UNIT NUMBER

STREET NAME

SUBURB

STATE

PIN CODE

INTRODUCED BY

Please transfer the membership fees to below bank account details, also include your name as reference number

Account Name: Rockhampton Malayalee Association Inc.
Bank: Westpac Bank
BSB: 034 636
Account # 363 953

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