Prime Timers Western Australia Inc.
Membership Application
Please fill in applicable* blanks BEFORE YOU click PRINT FORM sign and post
APPLICANT
 First Name *
 		 Surname *
 		 Date of Birth *
CO-APPLICANT
 First Name *
 		 Surname *
 		 Date of Birth *
     Anniversary *
 
 
 Address *
 		 Suburb *
 		 Post Code *
 Home Phone Number *
 		 Mobile Phone Number *
 Email Address *
 
   

 
Applicant
I declare I am eligible for membership (over 40 years of age)
and agree to abide by the Rules of Association of Prime Timers Western Australia Inc
Signature: Date:
   
Co-Applicant
I declare I am eligible for membership (over 40 years of age)
and agree to abide by the Rules of Association of Prime Timers Western Australia Inc
Signature: Date:
   
Membership Dues Single $30.00 per financial year
Couple $45.00 per financial year per household (2)
   
Mail your application form along with your cheque or money order
Please do not send cash
To
Prime Timers Western Australia Inc.
P O Box 829, Mt Lawley 6929