Sign up online 1 About you 2 Your address 3 Your workplace 4 Membership option First name* Last Name*Email address* Phone number*Gender*MaleFemaleDate of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920First Language Street Address*City / Suburb*State*Post Code* Company / Employer name*Employer Location*Position*AdultJunior / ApprenticeApprenticeship Commencement Date (if applicable)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Payment Type*Direct Debit Membership Level (Adult - Credit Card)*The listed amounts are those which apply from 1 July 2016Monthly1/2 YearlyYearlyMembership Level (Adult - Debit Credit Card)*The listed amounts are those which apply from 1 July 2016Monthly1/2 YearlyYearlyMembership Level (Junior / Apprentice - Credit Card)*The listed amounts are those which apply from 1 July 2016Monthly1/2 YearlyYearlyMembership Level (Junior / Apprentice - Debit Credit Card)*The listed amounts are those which apply from 1 July 2016Monthly1/2 YearlyYearlyMembership Level (Adult - Direct Debit)*The listed amounts are those which apply from 1 July 2016WeeklyMonthly1/2 YearlyYearlyMembership Level (Junior / Apprentice - Direct Debit)*The listed amounts are those which apply from 1 July 2016WeeklyMonthly1/2 YearlyYearlyFinancial Institution*Branch*Account Name(s)*BSB Number*Account Number*Total $ 0.00 Terms & Conditions*I hereby make application to be a member of the AMIEU Queensland Branch and the AMIUEQB and if accepted, agree to conform to the Rules thereof. I hereby authorise and request the AMIEU, APCA User ID Number: 067330. to, until further notice in writing, debit my/our account described above any amounts which the Australasian Meat Industry Employees' Union 067330 may debit or charge me/us through the Direct Debit System. RESIGNATION: Resigning from the Union must be done by written notice. Upon receipt of a written notice of resignation, your arrangement will be immediately stopped. ABOUT DIRECT DEBIT or CREDIT CARD: The AMIEU will provide 14 days’ notice prior to any changes to your direct debit or credit card arrangement. Small increases to periodic debit rates are made from time to time by decision of the Union Committee of Management. IF YOU WISH TO CANCEL OR CHANGE YOUR DIRECT DEBIT ARRANGEMENT, OR HAVE ANY QUESTIONS REGARDING YOUR PAYMENT, SIMPLY CONTACT THE UNION OFFICE ON TOLL FREE 1800 646 195. This recurring payment will be processed on the first pay period following receipt of this form. Payments will be processed as close as possible to your pay date. Please ensure that your nominated bank account has enough funds to cover your payment on the day it falls due. PRIVACY STATEMENT: The AMIEU is bound by the Privacy Act. All your direct debit or credit card information is kept confidential. Information is collected to enable the AMIEU to contact you about matters relating to your membership and to ensure that we have the necessary information to represent your employment and related interests. I/We accept the above terms and conditions and declare the information provided to be true and correct. Valid ID:*Please upload an image of your valid photo identification: Either your Drivers License or Passport. Drop files here or Captcha EmailThis field is for validation purposes and should be left unchanged.