The Seahorse Society of New South Wales Inc.

Founded in 1971
ABN 20 347 026 320
"Crossdress with Dignity"

MEMBERSHIP APPLICATION FORM

APPLICANT DETAILS

First Names: ________________ Surname: ______________ Date of Birth:  /  /  

Supporting Partner (if applicable)

First Names: ________________ Surname: ______________

I wish to be considered for membership of the Seahorse Society of NSW.
I agree to adhere to the rules of the Society (available on the website).

Signed: _____________________ Dated: _______________

CONFIDENTIAL CONTACT DETAILS

Postal address for mail and magazines, posted in a plain cover.

Mr / Mrs / Miss / Ms (circle one):

_______________________________________________

_______________________________________________

State: ____________________ Postcode: ______________

Country: ________________________________________

Female name (optional): ____________________________

SUBSCRIPTION

The annual subscription is $50, due on 1st March each year.
A pro-rata subscription should be included with your application as shown in the table below.
Subscriptions will only be refunded if you have an induction interview and you either withdraw your application or your application is unsuccessful.

Month of application

Pro-rata Subscription

Cheques/Money Order with application (tick box)

MAR

$50

[ ]

APR-MAY

$45

[ ]

JUN-JUL

$40

[ ]

AUG

$35

[ ]

SEP-OCT

$30

[ ]

NOV-DEC

$25

[ ]

JAN-FEB

$50
Membership valid for the following year

[ ]




INTRODUCING MEMBER (if applicable)

I am being introduced to the Society by a current member

Member's name: ___________________ Membership Number: ______

MEMBER REJOINING (if applicable)

I was previously a member of the Seahorse Society

Name: ___________________ Membership Year/Number: ______

HOW DID YOU FIND OUT ABOUT SEAHORSE? (Circle one)

WEBSITE | PHONE BOOK | GENDER CENTRE | FRIEND | OTHER

INDUCTION INTERVIEW &CONTACT DETAILS

How would you like to be contacted?

Email [ ]   Phone [ ]   Mail [ ]   (please tick at least one)

Your name for contact: ________________________________________

Email (optional): _____________________________________________

Phone Number (optional): ______________________________________

Preferred time to call: _________________________________________

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?

_____________________________________________

BACKGROUND

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

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Please send your completed application form together with your subscription to:

Membership Secretary
PO Box 6179
West Gosford, NSW 2250

Please pay by cheque or money order made payable to The Seahorse Society of NSW Inc. Do not send cash by mail.

Office Use Only
Induction by member ________________ on
Applicant wishes to join: Yes / No
Comments: