Membership Application Form Application for Associate Membership Form Name First Last Gender Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneMobile(Optional) ADF/CADET Service History? Years Of Service Unit (If Any) IF you do not have a firearms licence then by making this application you are declaring that you do not have a current conviction (LESS than 5 years old) that would disqualify me from Firearm Ownership.”If you have a Firearms Licence please advise the Type, Categories and Endorsements: Weapons Licence Longarms Cat Endorsed Weapons Licence Handguns Cat Endorsed Other Licence Type Other Licence Number Cat Endorsed MR1 & MR3 Categories can be endorsed on your Firearms/Collectors license by Weapons Licensing Branch (Q`ld Police Service) for re-enactment purposes ONLY – this will permit you to carry a firearm & to fire BLANK cartridges in a public place for the purposes of demonstration/display ONLY. (Police approval is required for the demonstration and the firearms checked by our an approved person/Arms curator). See the Arms Curator for assistance.(Police approval is required of the demonstration & firearms checked by our Arms curator). See the Arms Curator for assistance. Note: Collector Licensees who wish ONLY to satisfy their requirements that they are members of an Approved Historical Society, do NOT need MR1 & MR3. This is for reenactments only. IMPORTANT! Members who possess a current Firearm’s or Collector’s License please return a clear photocopy of both sides of the licence with this form. (This is for our records. This is part of our conditions as an Approved Historical Society (No: 4900000702), as required by Q`LD POLICE/ W.L.B. and for us to confirm that you are licensed. The information is stored secured & confidential by the membership secretary & is also available for use by the authorized person who fills out the QP 517 forms. – NO LICENSE PHOTO IS USED IN ANY MANNER.) Name Date MM slash DD slash YYYY Annual fees are #Adult – $60 (OVER THE AGE OF 18 YRS)..Junior – (13 TO 18 YRS WITH PARENTAL CONSENT) $20 Below Parent's Consent: Name 11th LH Museum helpers are always needed & appreciated! Would you like to help out on special days or for general working parties? Yes No Perhaps. Do you have any other skills? E.g.; Fitter, Boilermaker, Armourer, Carpenter, Electrical, Information Technology, Book Keeping Accounting CPA, etc. (If Yes or Perhaps the Curator of Arms will contact you about what is required) Would you like to make a Donation to the Museum? – Donations of $2 or more are Income Tax deductible and a stamped receipt can be issued, (tick box if receipt required. PLEASE ADVISE WHY YOU WISH TO JOIN THE TROOP AND HOW YOU CAN CONTRIBUTE TO THE TROOP AND THE MUSEUMPlease provide between 300 and 500 charactersDo you know any of the Troop members PAYMENT OPTIONS – IMPORTANT -, PLEASE READ CAREFULLY! a) Cheque made out EXACTLY to “The 11TH LIGHT HORSE CT MM ASN INC”. b) Cash is not preferred but may be sent to PO Box 315 Zilmere, Qld 4034, via a registered letter –make sure the money is in another envelope first. c) Direct Deposits via internet or through your bank, can be done to our Account. Direct Deposit Details are; Heritage Building Society “Club S21 Account” No: 7144318. BSB: No: 638070 Send a copy of the Deposit Slip with this form. THIS FORM MUST BE RETURNED REGARDLESS – WE NEED YOUR SIGNATURE & IF APPLICABLE PARENTS APPROVAL SIGNATURES ON THIS FORM. OTHERWISE YOUR APPLICATION WILL BE DELAYED. Fees for Junior Associate Members are 25 percent of Associate Member Fees. Δ
