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March 1, 2018


Membership Details


Employment Details

Type: Full timePart timeCasual



Payment Details

Customer Reference


Weekly ($11)Fortnightly ($22)Casual/Part-time ($5.50/week)


Continue regular debits until further notice


Choose your payment method (Credit Card or Direct Debit)

Debit from Credit Card

Card Type


Debit from Bank, Building Society or Credit Union Account

By signing this form, I/we authorise Ezidebit, acting on behalf of the Business, to debit payments from my specified Credit Card above, and I/we acknowledge that Ezidebit will appear as the merchant on my credit card statement. Furthermore, I/we agree to reimburse and indemnify Ezidebit for any successful claims made by the Card Holder through their financial institution against Ezidebit.

I/We authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID No 165969, 303909, 301203, 234040, 234072, 428198) to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with the Debit Arrangement stated above and this Direct Debit Request and as per the Ezidebit DDR Service Agreement (Ver 1.6) provided.


Digital Signature:


Member of convenience rule

You will not be covered for industrial/workplace issues that arose prior to becoming a member of APA (NSW) unless approved by the APA (NSW) Executive. In this instance, you will be considered a

I accept the above statement



I, the undersigned, hereby apply to become a member of the Australian Paramedics Association (NSW); I fully acknowledge and agree to abide by all rules and by-laws of the Association.

I accept the above statement

Application Submission

Note: Your membership is not confirmed till you have completed this application and receive a welcome letter from the Association.

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