I apply to become a member / renew my membership of the Queensland Justices Association. Ordinary Member $49.50 (Includes GST) Pensioner $37.20 (includes GST) Married Couple $55.00 (includes GST) Subscriptions are renewable on 1st September each year. From 1st February the following pro-rata membership applies. • Ordinary Member $4.10 per month or part thereof • Pensioner $3.10 per month or part thereof • Married couple $4.60 per month or part thereof Date: .................................................................... Member Number (if applic) I enclose $ Surname:
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for Ordinary / Pensioner / Married membership of the QJA
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Given Names:
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Preferred Title: Mr / Mrs / Miss / Ms / Dr / Other Postal Address:
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Home Address: Occupation:
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Telephone: .......................................................................... Mobile: .............................................................................. Email:
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Date of Appointment as a JP / JP (Qual) / C. Dec / ................ / .............. Date of Birth (Optional): .............. / .......... / ............
PAYMENT DETAILS: Cheque / Money Order / Bankcard / Visa / Mastercard Card No:
Expiry Date: .......... / .......... Signature:
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MAIL TO: THE REGISTRAR, QJA, PO BOX 8419, WOOLLOONGABBA QLD 4102