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ROYAL VICTORIAN

ASSOCIATION OF

HONORARY JUSTICES

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RVAHJ Membership Application and Payment Form

All Fields must be completed for a valid application to be processed. Enter N/A where a field is not applicable

Personal Details Personal details listed below are for association use only and will not be released other than as required by law
TITLE
Last Name:
Given Names:
Occupation:
Home Address:
Town/Suburb:
Post Code:
Phone:<
Fax:
Mobile:
Email:
Business Suburb
Business Postcode
Business Phone:
Date of Birth: DD: MM: YYYY:  
Gender: Male   Female
JP Number:
BJ Number:
Public Details Advise availability and  preferred  numbers for contact during  the  time frames  indicated where you can be contacted by people needing your services
Availability Any Time Business Hours After Hours
After Hours
Business Hours
BJ Primary Contact
Payment Details On submission, your card will be debited in the amount of $82.00 ($60.00 membership plus $22.00 joining fee) GST included. Your membership certificate will be mailed to your home address on acceptance by the board
Credit Card Type: Visa MasterCard
Credit Card Number: - - -  
Expiration Date: MM: YY:

 





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