Membership Application Form First name*Surname*Date of Birth* Date Format: DD slash MM slash YYYY GenderGenderMaleFemalePostal Address*Suburb*Postcode*State*State...QLDNSWACTVICSANTTASWAEmail* MobileTel HomeTel BusinessAre you in the food industry?* Primary food producer Wine /beverage producer Retail food outlet Food artisan Restaurant/café Chef / cook Other (please specify) No Other*Membership No. if renewingIs this a couples application? Yes SECOND PERSON'S CONTACT DETAILS First name*Surname*Date of Birth* Date Format: MM slash DD slash YYYY GenderGenderMaleFemaleEmail* MobileTel BusinessTel HomeMembership No. if renewingMEMBERSHIP AND PAYMENTNew or RenewI/we would like to become a Slow Food Noosa memberI/we would like to renew membership of Slow Food NoosaSubscription category/feeOne Year OptionIndividual (single person) $90Individual junior (<35 yrs next birthday) $30Individual mature (>65 yrs currently) $45Joint (two people, SAME residence) $105Joint junior (two junior people, SAME residence) $45Joint mature (two mature people, SAME residence) $60Three Year OptionIndividual (single person) $250Joint (two people, SAME residence) $295Preferred payment method*Bank transfer (please reference your EFT with your INITIALS and SURNAME e.g. K Smith)Cheque payable to Slow Food NoosaCash (only at events - not by post)Bank Details: Slow Food Noosa Acc: 121-060-792 BSB: 633-000 (Bendigo Bank Tewantin)Mail cheque and member names to: Slow Food Noosa P.O. Box 575 Noosaville LPO QLD 4566Privacy Act* In accordance with Australian Commonwealth and State privacy legislation and Italian legislative decree no. 196/03, I/we hereby grant permission for the use of my/our personal information for Slow Food association purposes and activities only. This iframe contains the logic required to handle Ajax powered Gravity Forms.
