[D] Payment of fees by Credit Card

To be returned to Membership Section, PSA/CPSU, GPO Box 3365, Sydney 2001 for processing.

Please use BLOCK letters or type all details)

Full name as on credit card

Card No

Expiry Date: _______/______/________

Master, VISA, or Bank?

Amount paid $ ________________________________ (Minimum is fee for one quarter)


Signature

Date ______/______/_______

PSA use only

Transaction completed

Date ______/______/________

When you have read the obligations print out this form, complete it, then sign it.

The completed form must be posted to us as we need your signature.