Public Service Association of SA

Community and Public Sector Union (SPSF Group) SA Branch

Membership Application Form

Personal Details

Title __________________________  Surname ____________________________________________

First name's ________________________________________________________________________

Home address  ______________________________________________________________________

Home phone  _______________ Gender  _____ Date of Birth  ______________
 
 
 

Employment Details

Department/Agency  _________________________________________________________________

Work address  _______________________________________________________________________

Work phone  ________________________________  Work fax  ______________________________

E-mail ____________________________________________________________________________

Full time                  Part time                Casual     (please circle)

Total hours worked per week ____________  Classification (eg ASO2) __________________

Occupation  ____________________________________  Increment  _____________

Annual salary  ______________   Referred by _________________________
 
 
 

PSA Membership I hereby apply to join the Public Service Association of SA and agree to be bound by the rules. CPSU Membership I hereby apply to join the Community and Public Sector Union, State Public Services Federation (SA Branch) and agree to be bound by the rules.   Signature_____________________________________ Date_____________________ I do/do not wish to receive a tax statement (please circle)

 

Please mail your completed application form to: Reply Paid Number 5306.  PSA/CPSU SA Branch GPO Box 2170, Adelaide, SA  5001 (no stamp required) For any further information call the PSA on (08) 8205 3200 or freecall 1800 811 457

Subscriptions are 0.95% of your substantive base salary (plus 0.095% GST) and are tax-deductable.  Unless otherwise notified,  direct debits occur on the first working day of each month.  Below is the authorisation for your subscription to be paid by direct debit.

To:  The Manager

Name of Credit Union/Financial Institution  ______________________________________________

Address of Credit Union/Financial Institution  _____________________________________________

I/we request you, until further notice in writing, debit my/our account described in the schedule below, any amounts which the Public Service Association of SA Inc, Community and Public Sector Union, (SPSF Group) SA Branch * (User ID 028498) may debit or charge me/us through the Direct Debit system.

I/we understand and acknowledge that the Credit Union/Financial Institution may in its absolute discretion determine:

1. The order of priority of payment by it of any money pursuant to this request or any authority or mandate.
2. At anytime by notice in writing to me/us terminate this request as to further debits.

Signature/s _________________________________________________________________________

Date ______________________________________________________________________________

Member's name  ____________________________________________________________________

Address  ___________________________________________________________________________

Account name  _____________________________________________________________________

BSB number _____________________ Account number _________________
 
 

Accounts

PSA/CPSU membership subscriptions may also be paid by cheque, money order or cash.
If paying via this method, please make cheques and money orders payable to the PSA/CPSU.

I wish to pay quarterly.            I wish to pay half yearly.                 I wish to pay annually.
 
 

Credit Card

To pay by credit card on a monthly basis, please complete details below.

Card number  _________________/___________________/__________________

Card Expiry Date  ____/____

Cardholder's name  ___________________________________________________

Card type                       Bankcard                 Mastercard               Visa    (please circle)

Signature ____________________________________________________________