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CiviCRM
Single-site Membership
Single-site Membership
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Please choose a membership option:
Membership Type
*
Small NFP education and care provider
-
$ 200.00
(includes GST of $ 18.18)
:
(<35 approved places)
Medium NFP education and care provider
-
$ 280.00
(includes GST of $ 25.45)
:
(36-60 approved places)
Large NFP education and care provider
-
$ 365.00
(includes GST of $ 33.18)
:
(>60 approved places)
NFP non-education and care provider
-
$ 250.00
(includes GST of $ 22.73)
Commercial/private organisation
-
$ 545.00
(includes GST of $ 49.55)
Total Amount
On Behalf Of Organization
Organisation Name
*
Phone (Main)
*
Street Address
*
City
*
State/Province
*
- select -
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Country
*
- select -
Australia
United States
Postal Code
*
Email
*
Please enter a Username to create an account. If you already have an account
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before completing this form.
Username
*
Check Availability
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Password
Confirm Password
Provide a password for the new account in both fields.
Primary Contact
Please enter the primary contact details.
First Name
*
Last Name
*
Email
*
Phone (Work)
*
Mobile Phone (Primary)
Position
Credit Card
Card Type
- select -
Visa
MasterCard
Amex
Discover
Card Number
*
Security Code
*
Expiration Date
*
-month-
Jan
Feb
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May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
-year-
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
Billing Name and Address
Billing First Name
*
Billing Middle Name
Billing Last Name
*
Street Address
*
City
*
Country
*
- select -
Australia
United States
State/Province
*
- none -
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postal Code
*