RAEME - ACT

ACT New Member Request

What type of membership are you requesting?

Membership type(*)

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What are your personal details?

Title (Dr, Mr, Mrs, Ms...etc)

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First Name(*)

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Surname(*)

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Preferred Name(*)

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Date of Birth

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What are your contact details?

Primary email address(*)

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Second email (if required)

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Main Phone Number

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Alternate phone number

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Address Line 1

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Address Line 2

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City

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Postcode

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What is your current service status?

Service Status

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Rank

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Unit

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Rank on Discharge

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Last Unit

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RAEME Trade or Affiliation

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