MEMBERSHIP - PTSD Resurrected Inc

Becoming a Member with PTSD Resurrected Inc

Kindly fill out the form below and select your membership preference.

Membership options are:

• Individual $10/Year

• Family $25/Year (kindly fill in all fields for Family Membership

• Corporate $100/Year

Bank Transfer

If you would prefer to make a direct bank transfer – please use the details below and email us a bank transfer receipt to [email protected]

ACCOUNT NAME: PTSD RESURRECTED
BSB: 064486
ACC: 10576811
REF: SURNAME + MEMBERSHIP TYPE

PTSD Res Membership Form

Step 1 of 3

Select Your Membership Type

Single Membership $10/Year:

One Person applying for membership

Price: $ 10.00

Family Membership $25/Year:

Two or more people on one form applying for membership

Price: $ 25.00

Corporate Membership $100/Year:

One Company or one Association applying for membership

Price: $ 100.00

Name(Required)

First Last

Email(Required)

Phone

Family Member #2 Details

Family Member #2 Name

First Name Last Name

Family Member #2 Phone

Family Member #2 DOB

Family Member #3 Details

Family Member #3 Name

First Name Last Name

Family Member #3 Phone

Family Member #3 DOB

Acknowledgement

Please acknowledge by checking each box:(Required)

BY CHECKING THIS BOX: I DECLARE THAT ALL MEMEBERS ON THIS FORM ARE OVER 16 YEARS OF AGE. I UNDERRSTAND THIS MEMBERSHIP IS NOT TRANSFERRABLE. I UNDERSTAND FEES MUST BE RECEIVED BEFORE MEMBERSHIP IS AGREED. I UNDERSTAND FEES ARE ANNUAL AND RENEWABLE ON 1st FEBRUARY EVERY YEAR. I AUTHORISE THE VERIFICATION OF THE INFORMATION ON THIS FORM.

MEMBER #1 SIGNATURE: BY CHECKING THIS BOX I AGREE THAT THIS CHECK SERVES AS A SIGNATURE REPRESENTATION.

Acknowledgement for Family Memberships

MEMBER #2 SIGNATURE: BY CHECKING THIS BOX I AGREE THAT THIS CHECK SERVES AS A SIGNATURE REPRESENTATION.

MEMBER #3 SIGNATURE: BY CHECKING THIS BOX I AGREE THAT THIS CHECK SERVES AS A SIGNATURE REPRESENTATION.

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

Credit Card

Feed Required: To use the Stripe field, please create a Stripe feed for this form.

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Becoming a Member with PTSD Resurrected Inc

Bank Transfer

PTSD Res Membership Form

Select Your Membership Type

Family Member #2 Details

Family Member #3 Details

Acknowledgement

Follow Us

REBOOT TRAUMA RECOVERY IS PROUDLY PRESENTED BY PTSD RESURRECTED INC.

MAJOR SUPPORT PARTNER

2024 CHARITY PARTNER

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REBOOT COURSE

WE ARE A REGISTERED CHARITY WHO SUPPORT INDIVIDUALS AND FAMILIES SUFFERING FROM TRAUMA AS A RESULT OF THEIR SERVICE. RESTORING HOPE, HEALING AND PURPOSE TO OUR VETERANS AND FIRST RESPONDER COMMUNITY.

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