School Membership

Membership pricing

$109 per year: School with a canteen (school-run)
$299 for three years: School with a canteen
$109 per year: School with a canteen (run by a leasee) OR $99 if the leasee is a member
$79 per year: School with no canteen

Name of School*

Contact Name*

Position*

School Mailing Address*

Street Address City State Postcode Country

School/ Canteen Phone*

School/ Canteen Fax

Canteen Email*

School Email

Number of Students*

Type of canteen management*

Parent body
Principal-run
Leased

Leasee Name*

Leasee Contact Phone*

Is Leasee a "Leasee Member" of Healthy Kids Association?*

Yes
No

Days of operation

Monday
Tuesday
Wednesday
Thursday
Friday

Payment Options

Direct Deposit
Cheque
Credit Card

Membership option select:*

School WITH a canteen - 1 year ($109)
School WITH a canteen - 3 years ($299)
School with a leased canteen AND leasee is a member - 1 year ($99)
School with no canteen - 1 year ($79)

Membership Number*

Total

$ 0.00

Credit Card

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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