Joining and Renewal of membership of

Psychology for a Safe Climate

Name:

Address:

Email address:

Please tick the appropriate box(es) relevant to your payment

Joining fee:	$20 ($10 concession)

Annual fee for current members:	$20 ($10 concession)

I would like to make a donation to help finance our activities:	$

Total amount payable:	$

Payment – please tick appropriate box

Payment by cheque:

Make payable to:	Psychology for a Safe Climate

Mail this form with your payment to:	R Crettenden

Treasurer PSC

201/416 Auburn Rd

Hawthorn 3122

Bank details for payment by direct debit:

Psychology for a Safe Climate

Bendigo Bank

BSB: 633-000

Account Number:149672792

Please include your name when making payment.

Email this form to rcrettenden@bigpond.com