Membership Application Form

Application Form

To become a member of the Association, individuals must be at least fifty-five years old, fill out the complete form below, and pay the membership fee at the time of joining. Membership runs from January 1st to December 31st each year.

First Name *

Last Name

Date of Birth *

Phone Number

Mobile Number

Your Email *

Acknowledgement *

I wish to apply/renew membership of Fiji Senior Citizens Association of South Australia Inc. I undertake to abide by the rules and regulations of the Fiji Senior Citizens Association of SA Inc.

Address - Street

Suburb

Post Code

Date*

Custom Text

I give my consent

Custom Text

I do not give my consent :

to the Club to take group or individual photograph of myself. The Club will keep the photos as record and also may load on Club's Website.

Submit