Member 1
Mr Mrs Ms Miss Dr
Title
(please circle one)
NEW MEMBERSHIP Application form
(Please print clearly)
Applications can also be completed on-line at www.arpaactiveover50s.com.au
Member 2
Mr Mrs Ms Miss Dr
Title
(please circle one)
Family Name
Family Name
First name
First Name
Preferred Name
Preferred Name
Year of Birth
Vocation
Year of Birth
Vocation
Phone
Phone
Mobile Phone
Mobile Phone
(present or former)
(present or former)
Postal Address
Suburb
Postcode |__|__|__|__|
Email Address
Introduced by.....................................................................................
Type of Membership
(Please tick)
Member No.............................................
Single
12 months - $31
3 years - $76 (Save $17)
Joint
12 months - $53
3 years - $126 (Save $60)
May we post you a lottery book to help with our fundraising
Office Use Only
YES
NO
Date Paid …...../……/…….
Membership number ………………………………
Payment amount $.......................... Renewal Date………/………/………
Receipt Number …………………………………………
Payment made by (tick appropriate box)
Pay to:
Card Number
Expiry date
Name on card .............................................................................
Signature
.............................................................................
Return form to : ARPA Active Over 50s, PO Box 8247, Station Arcade,
Adelaide, SA 5000
Acct No. 112785540
BSB No. 105-022
Payee:
Australian Retired
Persons Assoc.(SA)
Inc
Type your phone
number into the
payment details field
Which ARPA activities are you interested in?
Adventure Group
ARPA Radio Players
Art Appreciation
Art
Auction Bridge
Backyard F&V Gardening
Badminton
Board games/ Scrabble
Bolivia
Book Discussion
Bowls - Carpet
Bushwalking
Cards
Caravan Group
Choir
Computer Group
Computer Lessons
Cycling
Craft
Darts
Dominoes
Dressmaking
Four Wheel Drive
Geocaching
(tick your preferences)
Golf
Guest Speakers
Internet &/or IPAD Lessons
Investment & Self Funded Super
Keep Fit / Exercise
Mah Jong
Orchestra
Outings - Day trips / Lunches
Photography
Pleasure Fishing
Rummikin
Snooker / 8-Ball
Spanish for Beginners
Sunday Lunch Group
Tai Chi
Table Tennis
Tap Dancing & Variety
Tennis
Train the Brain
Travel Scene
Triominoes
Weekly Walkers
Wine Tasting & Social Group
Other? ..................................
Have you seen any ARPA advertising?
Yes
No
Yes
No
Was the Advertising in
SA 50s Lifestyle
The Senior
CWA Magazine
ARPA Brochures
Internet
Have you been to the ARPA website?