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Membership Sign-up Form
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Are you a member
- Yes
- No
This Sign up form is only..
I am here to
I am here to(Required)
- Renew my membership
- Apply for a new membership
First Name(Required)
Last Name(Required)
Company / Organisation / Club
Phone
Email(Required)
Address Line 1
Address Line 2
City
Postcode
State
How did you hear about PBF?(Required)
Other/notes
Add any notes about how you heard about PBF.
Membership Number
First Name(Required)
Last Name(Required)
Phone
Email(Required)
Date of Birth(Required)

Choose your Annual Membership Option
Please see your renewal notice for details of your membership
If you want to make any changes to your membership details or have any questions please contact us or call 1800 809 780
Want to renew more than one membership?
No problem! Just click the plus button or type in the number of each membership type you'd like to renew.
Want to purchase more than one membership?
No problem! Just click the plus button or type in the number of each membership type you'd like to purchase. For example, if you'd like to purchase a membership for yourself and one double membership for a friend and their partner, press the "+" next to single and then double once, or type "1" into each of those fields. Any questions? Contact us or call 1800 809 780
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Membership type Single
- Single
$55
Single - $55
Please enter a number from 1 to 5.
$55
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Membership type Double
- Double
$80
Double - $80
Please enter a number from 1 to 5.
$80
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Membership type Family
- Family
$95
Family - $95
Please enter a number from 1 to 3.
$95
PBF offers flexible membership options for all combinations. Click here to find out which membership option is right for you.

Please Input Membership Details

If you'd like to include more than 4 children under 18 in your family membership, please contact us or call 1800 809 780
Single Membership Details
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Adult 3
Name(Required)
DOB(Required)
Adult 4
Name(Required)
DOB(Required)
Adult 5
Name(Required)
DOB(Required)
Double Membership Details
Double Group 01
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Double Group 02
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Double Group 03
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Double Group 04
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Double Group 05
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Family Membership Details
Family Group 01
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Child Under 18
Name(Required)
DOB(Required)
Child Under 18
Name
DOB
Child Under 18
Name
DOB
Child Under 18
Name
DOB
Family Group 02
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Child Under 18
Name(Required)
DOB(Required)
Child Under 18
Name
DOB
Child Under 18
Name
DOB
Child Under 18
Name
DOB
Family Group 03
Adult 1
Name(Required)
DOB(Required)
Adult 2
Name(Required)
DOB(Required)
Child Under 18
Name(Required)
DOB(Required)
Child Under 18
Name
DOB
Child Under 18
Name
DOB
Child Under 18
Name
DOB

Would you like to make a donation?
Would you like to make a donation
- $25
- $50
- $100
- Other
- None
Other Amount

Summary

After you press Submit you will be taken to the St George secure banking website.
Single Package
Double Package
Family Package
Donation
Total Cost:
Total Cost
Price: $ 0.00
Total
$ 0.00
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PBF Membership

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Speakers

Injury Prevention Programs

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Spinal Cord Injury Support

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Our Organisation

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Join Paraplegic Benefit Fund Australia

PBF Membership

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Speakers

Injury Prevention Programs

–

Spinal Cord Injury Support

–

–

Our Organisation

–

–

Join Paraplegic Benefit Fund Australia

Membership Sign-up Form

I am here to

Choose your Annual Membership Option

Please see your renewal notice for details of your membership

Want to purchase more than one membership?

Please Input Membership Details

Single Membership Details

Double Membership Details

Double Group 01

Double Group 02

Double Group 03

Double Group 04

Double Group 05

Family Membership Details

Family Group 01

Family Group 02

Family Group 03

Would you like to make a donation?

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