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         Member's Information

           First Name:        Last name: 
           Address Street Name:
                      Suburb/Town:
                                   State:
                            Post Code:
                                 E-mail:


         Pledge Information

           I pledge a total of $ 
           to be paid monthly, quarterly or yearly  
           I plan to make this contribution in the form of cash, cheque or others  
           Please use the word 'E-mail' or 'Post' to choose your preferable future correspondent method with us