VCPS Membership Application Form

Membership Type:
New Member Renewal Change of Address

Journal Subscription:
Digital Journal ($18) Digital + Paper Journal ($30)

Membership Payment:
Enclosed Direct Deposit (copy of receipt attached) Via paypal
Not Applicable (change of address only)

Full Name:

Current Address:

Phone:
B.H.
A.H.
Mobile

Email Address:(hotmail not permitted,gmail or yahoo ok)


Additional Comments


Where did you hear about the VCPS? (New members only)


Credit Card Details (not available where applicant resides within Australia)
Expiry Date

Card Type: Visa MasterCard

Privacy Consent: I consent to my personal details (as above) being shared with other VCPS members for communication purposes only. (They will not be disclosed to any third party.) See the VCPS Privacy Policyfor more information.
Signature & Date:


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Note: Membership is subject to approval by the VCPS Committee.