Postal Form for Payment by Mail

Please print and send this form if you are paying twenty dollars per year (AUD$20) for Membership by Cheque or Money Order or if you are providing your Credit Card details by post. 

If you are renewing your membership, please do not choose another Username and Password as your original access details will be maintained. If you have forgotten your Username and Password or your Membership expiry date,  Check Password/Username/Expiry Date  for your details and your access details will be emailed to you at the address you provided CLW when registering for membership. If you need any further assistance, please Email me

Name:
User name: (1st choice)
User name: (2nd choice)
Password:

Occupation/Position:                                       Age:

Telephone (to confirm details if required)

Email Address where your Username, Password, E-News will be sent to:

 

Payment Method:  Cheque (    )   Money Order (   )   Credit Card by post (   )

Credit Card - Card Type: Visa (    ) Mastercard (      ) Bankcard (    )

Card Number:        _  _  _  _      _  _  _  _      _  _  _  _      _  _  _  _

Expiry:            Month:                           Year: 20

Name on Card:
How did you find out about the Centre? (please circle)

Search Engine, Links, Articles, Another Person, Advertisement, other:

Please note Cheques and Money Orders in Australian Dollars only are to be made payable to: The Centre for Leadership for Women
Postal Address:   The Centre for Leadership for Women, PO Box 3144,  Minnamurra  NSW 2533
Membership fees are not subject to GST.  

For your own records, please retain the email you receive with your Username and Password to access CLW. Thank you.
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