Online membership form

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Subscription ID

PAYEE

Payer's First Name(Required)

Payer's Last Name(Required)

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Payer's Full Name

Payer's Email Address(Required)

MEMBERSHIP SECTION

Membership(Required)

New Membership
Membership Renewal

Type of Membership(Required)

Student Membership ($10.00)
Individual Membership ($20.00)
Family Membership ($30.00)

I wish to make a donation as part of my subscription(Required)

Yes
No

Donation Amount(Required)

Minimum Donation

Please note: The minimum donation amount is $2.00.

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Subscription

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Donation

MEMBER SECTION

Member Name(Required)

Email Address(Required)

Member Name 1(Required)

Email Address 1(Required)

Member Name 2(Required)

Email Address 2(Required)

Have your Contact Details changed since last year?(Required)

Yes
No

CONTACT DETAILS SECTION

Postal Address(Required)

Postal Address

Phone Number

PAYMENT SECTION

Payment Method(Required)

Credit Card/Debit Card
Apple Pay
PayPal
Funds Transfer using PayID
Funds Transfer using BSB Number and Account Number

Total Amount Owing

$ 0.00

Credit Card/Debit Card Option

Once you press the Submit button, you will be presented with a Stripe payment page where you will be asked to pay the amount shown above.

Apple Pay Option

NOTE: You will need to use an Apple device (+ Safari) to use this option. If you are not using an Apple device (+ Safari), please select another option.

Once you press the Submit button, you will be presented with a Stripe payment page where you will be asked to pay the amount shown above.

PayPal Option

Once you press the Submit button, you will be presented with a PayPal payment page where you will be asked to pay the amount shown above.

PayID Option

Once you press the Submit button, please login to your Internet Banking service and pay the amount shown above to this PayID: 0412265547

Funds Transfer Option

Once you press the Submit button, please login to your Internet Banking service and pay the amount shown above into this Bank Account.
    Bank Name: Bendigo Bank
    Account Name: Fitzroy History Society Inc
    BSB Number: 633000
    Account Number: 151620127

Comments/Special Requests

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OFFICE USE ONLY

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Offline Payment - Date Paid

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Offline Payment - Amount Paid

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Offline Payment - Payment Status

Step 1 of 2

PAYEE

MEMBERSHIP SECTION

MEMBER SECTION

CONTACT DETAILS SECTION

PAYMENT SECTION

Once you press the Submit button, you will be presented with a Stripe payment page where you will be asked to pay the amount shown above.

NOTE: You will need to use an Apple device (+ Safari) to use this option. If you are not using an Apple device (+ Safari), please select another option.

Once you press the Submit button, you will be presented with a Stripe payment page where you will be asked to pay the amount shown above.

Once you press the Submit button, you will be presented with a PayPal payment page where you will be asked to pay the amount shown above.

Once you press the Submit button, please login to your Internet Banking service and pay the amount shown above to this PayID: 0412265547

Once you press the Submit button, please login to your Internet Banking service and pay the amount shown above into this Bank Account. Bank Name: Bendigo Bank Account Name: Fitzroy History Society Inc BSB Number: 633000 Account Number: 151620127

OFFICE USE ONLY

Once you press the Submit button, please login to your Internet Banking service and pay the amount shown above into this Bank Account.
Bank Name: Bendigo Bank
Account Name: Fitzroy History Society Inc
BSB Number: 633000
Account Number: 151620127