Membership Form

Welcome to Uttar Pradesh Association of Australia (UPAA) Inc. We are part of a greater family of all the people represent Uttar Pradesh & its language & culture.

To become a member of UPAA, please fill in the following membership form with your correct contact details. Once your payment is received, your membership will be confirmed and Membership number will be assigned to you. A copy of the members' directory is published every year.

Your name and contact details will be included in the next publication.

Please take time to review and update your contact details. This will allow UPAA to keep you informed of activities and update the member database and direct.

Details

The following prices are for a yearly membership pass and will need to be Join/Renewed in 2016.

Membership Types and Prices

Family: $20.00 (Couple and dependent kids)
Individual/Senior Family: $10.00
Student: $5.00 (ID required; to be provided on request)

*Note that individuals over 25 years of age will be considered as 'Individual Members'.

Payment methods

Online transfer (preferred)
Deposit in any ANZ branch into Uttar Pradesh Association of Australia Account.

Banking Details

Bank name: ANZ Ban Account Name:“Uttar Pradesh Association of Australia Inc.” BSB: 013 128 A/C: 406886956 For online transfer, use the reference example as MR. XXX Surname or MR - Member's No.

Existing Member*

Yes
No

Type of Membership*

Family (Couple and dependent kids)
Individual/Senior Family
Student

First Name (Primary Member)*

Surname (Primary Member)*

Children Name :

1.

2.

3.

4.

Contact Detail

Address*

Street Address Suburb State / Province / Region ZIP / Postal Code

Home Phone

Mobile

Email*

Origin in India

Primary Member Home Town*

Primary Member State*

Consent

Consent to publish details UPAA Directory*

Yes
No

Declaration

I confirm that all the above details are correct and allowed UPAA to store my detail in their records and use the same for the communication such as newsletter and events.

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