Thank you for your interest in joining our club.

We are always looking for like-minded veterans to join, if you meet the criteria to become a Patched Member then don't hesitate, complete the form and join now.

If you don't want to become a Patched Member, not to worry, we also have a supporter and Social membership available.

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Membership Type
  • - select a option -
  • Patched Member
  • Supporter Member
  • Social Member
- select a option -
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Field is required!

By selecting this membership category the applicant will be subjected to a 12 month (maybe sooner) probationarly period. During this period the Prospective Member (Prospect) must show committment to the club.

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Field is required!

This membership category is for persons who are family of Patched Members and persons who wish to be apart of the club with out heavy committment.

Please peovide your Sponsors name below.

Your Sponsor may be your husband, wife, boyfirend etc.

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Field is required!
Sponsor
Sponsor
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Field is required!

Personal Details

First Name
Your First Name
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DOB
Select a date
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Field is required!
Surname
Your Last Name
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Field is required!
Age
Your current age
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Field is required!
Address
Your Address
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Field is required!
Suburb/City
Suburb/City
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Field is required!
State
  • - select a option -
  • ACT
  • NSW
  • QLD
  • VIC
  • SA
  • WA
  • NT
- select a option -
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Field is required!
Postcode
Postcode
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Field is required!
Mobile
Your Mobile number
Invalid phonenumber!
Invalid phonenumber!
T-shirt size
Your T-shirt size
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Field is required!
Email Address
Your E-mail Address
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Next of Kin Details

Marital Status
  • - select a option -
  • Single
  • Married
  • Defacto
- select a option -
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Field is required!
Does your partner live with you?
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Field is required!
NOK First Name
NOK First Name
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Field is required!
Mobile
Mobile number
Invalid phonenumber!
Invalid phonenumber!
NOK Last Name
NOK Last Name
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Field is required!
Email
NOK E-mail Address
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Field is required!

Emergency Contact

First Name
First Name
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Field is required!
Mobile number
Mobile number
Invalid phonenumber!
Invalid phonenumber!
Surname
Last Name
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Field is required!
E-mail address
E-mail address
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Field is required!
Address
Address
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Field is required!
Suburb/City
Suburb/City
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Field is required!
State
  • - select a option -
  • ACT
  • NSW
  • QLD
  • TAS
  • VIC
  • SA
  • WA
  • NT
- select a option -
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Field is required!
Postcode
Postcode
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Field is required!

Vehicle Details

Type of vehicle
  • - select a option -
  • Motorbike
  • Car
  • Truck
- select a option -
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Field is required!
Make
Make
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Field is required!
Add another vehicle
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Field is required!
License number
Your License number
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Field is required!
Model
Model
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Field is required!
State
  • - select a option -
  • ACT
  • NSW
  • QLD
  • VIC
  • TAS
  • SA
  • WA
  • NT
- select a option -
Field is required!
Field is required!
Registration
Registration
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Field is required!
Type of vehicle
  • - select a option -
  • Motorbike
  • Car
  • Truck
- select a option -
Field is required!
Field is required!
Make
Make
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Field is required!
Model
Model
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Field is required!
Registration
Registration
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Field is required!

Military service

Service type
  • - select a option -
  • Army
  • Navy
  • Airforce
  • No Military Service
- select a option -
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Field is required!

There is nothing to complete in this section, please proceed to the next section of this form.

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PMKeyS number
Your PMKeyS number
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Field is required!
Service
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Field is required!
Enlistment date
Select a date
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Field is required!
Regimental number
Your Regimental number
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Field is required!
Length of service (years)
Your length of service in years
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Field is required!
Service status
  • - select a option -
  • Currently serving
  • Medical Discharge
  • Administrational Discharge
  • Compulsory Retirement Age (CRA)
  • Honorable Discharge
- select a option -
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Field is required!
Service date
Select a date
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Field is required!

Honors & Awards

Medals

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Field is required!
Others not listed
Others not listed
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Field is required!

Commendations & Badges

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Others not listed
Others not listed
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Field is required!

Acknowledgement(s):

I acknowledge that the information I have provided in this application is true and correct at the time of submission and agree to the terms, conditions, constritution and by-laws of Townsville Veterans Australia.

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Payment

Membership Fees

  • Patched member - $50.00 **
  • Supporter member - $0.00
  • Social member - $0.00

** Prorata payment of $25 is due for Patched Membership applications submitted after the second week of the month, then the full amount thereafter.

Bank Details

Bank: Bendigo
Acc No.: 119383362
BSB: 633000
Reference: "Your name"

Your application will be finalised after payment is made and received.

Please check over your application, sign, date, then submit.

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Signature
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Date
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Submit

Administration only

Action
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Secretary
Secretary
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Date completed
Select a date
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