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Australian Spiritualist Union of Churches P.O. BOX 273, PENRITH. NSW. 2751. ABN: 74.875.781.278. PHONE/FAX 1300.880.675 Email: rev_meggals@hotmail.com or secretary@australianspiritualistunion.org MEMBERSHIP/APPLICATION FORM Annual Renewal Individual Insurance Individual No.
... Concession Group New Application Group Previous Member A copy of Concession Card is required if applying for Concession Membership DETAILS: INDIVIDUAL MEMBER OR LEADER OF CHURCH, CENTRE OR GROUP Members First Family Title
Name
........ Name
. Home
. Home Address:
.. Phone:
.... Town/Suburb:
Home Fax:
... State:
... Postcode:
.. Mobile:
. Email:
... Mail
.. Address:
. DETAIL CHURCH, CENTRE, GROUP OR BUSINESS NAME Group Name:
... Venue Address:
.. Town/suburb:
.State:
... Postcode:
.. Frequency of meetings:
...................................... Your Services: (or abilities): Yes No Office use only 1. Do you provide Church Platform Work /Proof of Survival
........ date rec 2. Do you provide Psychic/Spiritual Readings.
...... P/Lfees 3. Do you provide Psychometry/Clairvoyance/Mediumship
....... M/C ok 4. Do you provide Healing/Counselling/Advisory services
..... Certif issue 5. Do you provide Natural Therapies/Complementary Medicine
........ Card issue 6. Do you provide Products manufactured or delivered
....... Renewal of MEMBERSHIP AND INSURANCE is due 1st March each year. Group/Business details are public. Personal details are kept in accordance with the Privacy Act. We/I agree to uphold and abide by the ASU of Churches conditions of membership and the Code of Conduct. Date
.. Signature
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