Pay your 2017-2018 Membership
$55 Single membership $95 Couple membership

TOTAL amount including membership & a donation *
Card type *
Name on card *
Credit Card Number *
Expiry Date *


Your Details:

First Name *
Surname *
Company (if applicable)
Position (if applicable)
Email *
Tel (day) *
Tel (eve)
Address (line 1) *
Address (line 2)
Suburb *
State *
Postcode *
Date of Birth (dd/mm/yyyy)

first member's name
second member's name
Please indicate if you do not wish to be listed in the Montefiore Annual Report
$55 = Single membership (1 vote at AGM)
$95 = Couple membership (2 votes at AGM)
I would like information on becoming a volunteer
Please send information regarding leaving a Gift in my Will to Montefiore

In accordance with the Rules of the Montefiore Home to be eligible to vote at the AGM a person must be a Life Governor or a financial member in respect of the financial year preceding the date of the AGM at which they intend to vote. Please note that this membership form relates to the 2017/18 fin yr. Accordingly payment of your membership must be received no later than the end of the respective fin yr, being 30 June 2018 will entitle you to vote at the 2018 AGM. Thank you for your support.