MEMBERSHIP APPLICATION FORM

This is our on-line Membership Application Form. Please fill it out as accurately and as fully as possible.

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Indicates required information.

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APPLICANT DETAILS

First Name (male/female):
Surname:
Email:
Date of birth (dd/mm/yyyy):	//
Femme name:

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SUPPORTING PARTNER (if applicable)

First Name:
Surname:

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MEMBER REJOINING (if applicable)

I was previously a member of the Seahorse Society

Name:
Member Year/No:

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INTRODUCING MEMBER (if applicable)

I am being introduced to the Society by a current member

Member's name:
Member No:

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CONFIDENTIAL CONTACT DETAILS

Name and postal address to appear on the envelope for mail and magazines, posted in a plain cover.

Leave empty if you do not wish to receive Seahorse mail.

Title:	| Mr: | Mrs: | Miss: | Ms: |
Name:
Street address:
Suburb/Town/City:
State:	Select one NSW ACT NT QLD SA TAS VIC WA Not in Australia
Postcode:
State, Country (If not Australia):

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BACKGROUND

To assist with processing your application, please briefly describe your interest in cross-dressing.

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HOW DID YOU FIND OUT ABOUT THE SEAHORSE SOCIETY?

Select one from the menu. This website Another website The Gender Centre Friend Seahorse Member Health Professional Magazine article Other source

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INDUCTION INTERVIEW CONTACT DETAILS

How would you like to be contacted to organise your interview? Not required for rejoining members.

Please select at least one:	Email Phone Mail to your contact address above
Your contact name:
Email address:
Phone Number:
Preferred time to call:

To assist with making contact with the appropriate Big Sister for your area, please one of the following.

Select one from the menu. Central Coast North of the Harbour South of the Harbour West/Hills District Penrith/Blue Mountains South Coast Northern Beaches Newcastle/Hunter Other Areas

If you would like to give a preference for arranging your induction interview, we will try to accommodate it.

Where (suburb/town) and when (day/time) would be most convenient?

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SUBSCRIPTION

Please note
Applications will not be processed until payment is received. Subscriptions will only be refunded if you have an induction interview and you either withdraw your application or your application is unsuccessful.

More details about subscription payments can be found here (opens in a new window/tab)

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I wish to be considered for membership of the Seahorse Society of NSW.

I agree to adhere to the Rules and follow the Guidelines of the Society (both open in new window/tab).
You must agree to this to proceed

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Have you filled in all the required information marked ?