RSL-SA,NT Application for Membership RSL Darwin Sub-Branch Membership Information You have selected the Pending Approval membership level. The price for membership is $0.00 now. Account Information Username Password Show Password Confirm Password Email Address Confirm Email Address Full Name LEAVE THIS BLANK Already have an account? Log in here Type of Membership Which type of membership are you applying for? Service Membership Affiliate Membership When you apply to or renew a RSL membership, you must prove your identity.The documents use to prove your identity include: Military Identification; or- Enlistment Certificate or Discharge Certificate; or- Service Record or PmKeys Record. Those documents allow us to: conduct a national criminal history check (if required), conduct a sex offender register check, gather any findings of misconduct by a reporting body, be assured you are who you say you are. What is your reason for joining as an Affiliate Member? Immediate family member served (immediate includes grandparents) Currently or previously worked as a defence contractor A Friend Other Please type another option here When you apply to or renew a RSL membership, you must prove your identity. The documents use to prove your identity include: NT Recognised Government Identification Card, Driver’s Licence / Passport / Birth Certificate. Those documents allow us to: conduct a national criminal history check (if required), conduct a sex offender register check, gather any findings of misconduct by a reporting body, be assured you are who you say you are. Personal Details Title First Name Last Name Post Nominals (Honours / Awards / Decorations) (Campaign and service medals can be listed later on form) Residential Address City Residential City State Residential State Postcode Residential Postcode Postal Address (Only complete this if it is not the same as your residential address) City Postal City State Postal State Postcode Postal Postcode Mobile Phone Number Mobile Phone Number Home Date of Birth Sex Male Female Country of Birth Billing Address First Name Last Name Address 1 Address 2 City State Postal Code Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands US Armed Forces Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Phone Payment Information Pay with Credit Card Card Number Expiration Date CVC Processing…
