Online Membership Form

Title:

First Name:

Surname:

Postal Address:

Suburb:

State:

Post Code:

Contact Number:

Mobile:

Email:

Date of Birth:

Employer:

Store Location:

Occupation:

Student:

	Yes
	No

Type of Employment:

	Full Time
	Part Time
	Casual

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By submitting this form I hereby agree to become a member of the Shop Distributive and Allied Employee's Association, Tasmanian Branch. I pledge myself to comply with the Rules of the Association, and with any amendments or additions which may be duly made to such Rules.

Paul Griffin
General Secretary