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Membership Application Form

Electoral Reform Society of South Australia (ERS SA)

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Would you like to remain on the ERS SA mailing list?
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Membership Details

I wish to apply for / renew membership of the Electoral Reform Society of South Australia for the period 1 October to 30 September.

Annual Subscription Fees:

• $15.00 — Standard Membership
• $10.00 — Pensioners or Full-Time Students

☐ Apply for / Renew Annual Membership
☐ Apply for Life Membership — $150.00 (once only)

Optional Donation

I enclose a donation of $__________ to support the work of the Society.

Membership Agreement

I understand that membership of the Electoral Reform Society of South Australia also includes membership of the Proportional Representation Society of Australia, of which the ERS SA is the South Australian Branch.

Signature: ___________________________________
Date: ________ / ________ / 20______

Member Details

Field	Information
Title
Given Names
Surname
Address
Phone
Fax
Mobile
Email

How to Submit

Please print this form and send it with your payment to:

ERS Secretary
11 Yapinga Street
South Plympton SA 5038

Payment options:
Cheques or money orders should be made payable to “Electoral Reform Society of SA”.