_____________________________________________________________________________

Credit Card Number:
 

__________/__________/__________/__________  Expiry Date:  ______/______
 

Visa card/Bankcard/Mastercard (delete as required)

I hereby authorise the PSA/CPSU to debit my credit card on a

Monthly _______  Quarterly ______ Half Yearly  ______  Yearly  _______
 

Signature:  _________________________________________  Date:  ____/____/____
 

Please note:  PSA/CPSU subscriptions are calculated at 0.95% of annual salary (plus .095% gst).