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Leasee Membership

Membership runs from a year of receiving payment.

Membership pricing
New membership: = $199.00 Renewal: = $199.00 All prices are inclusive of GST Note there is a now flat pricing for all Leasees regardless of how many school canteens you operate.
Name of Organisation*
Contact Person*
Position*
School Mailing Address*
Street address/ PO Box City State Postcode Country
School/ Canteen Phone*
School/ Canteen Fax
Canteen Email*
Canteen Email (if applicable)
In order to best support you, we would like the details of the schools you manage. This information is for statistics and to ensure we can serve our members well. It will not be passed onto any other authorities.
Please detail below the schools leased*
Name of School Suburb
Membership option selection:*
- New Members: 1 year
- Renewal: 1 year
Membership Number*
Total
$ 0.00
Payment Options
- Direct Deposit
- Cheque
- Credit Card
Credit Card

Discover
MasterCard
Visa
Supported Credit Cards: Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
*Visa/MasterCard payment incurs an additional 1% surcharge. Sorry, we do not accept Amex.
Credit Card Surcharge*
Price: $ 0.00
Deposit instructions

Account name: Healthy Kids Association
BSB: 012 290
Account number: 481362044

Reference In order to track your payment and ensure membership is updated, please insert your membership number (renewals) or school name, suburb (new) as the reference.

Please note: Direct deposit payments will not be processed unless a remittance advice is forwarded along with the application!
Pay by Cheque instructions

Please return the cheque or money order payable to Healthy Kids with a printout of the confirmation email you receive on submission of this form to:
Healthy Kids Association
Suite 1.02, 38 Oxley St
St Leonards, NSW 2065
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Phone
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Leasee Membership

Leasee Membership

Membership pricing

Deposit instructions

Pay by Cheque instructions

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Name of School	Suburb

Leasee Membership

Leasee Membership

Membership pricing

Deposit instructions

Pay by Cheque instructions

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