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Please use the form below to apply for membership of PAN. An * denotes manditory fields or sections.

Please be aware that some of our payment options are seperate to this form, however we do have a PayPal option which will enable you to sign up completely online.

Membership Type *
Membership Type

Concession Type and Number

If you are claiming a concession please supply your concession type and ID number.


Membership Period *
Memberships Period

Personal Details
First Name *
Last Name *
Member number	(Member number only applicable if you are renewing, otherwise leave it blank)
Street address *
Suburb *
Postcode *
State *
Phone
Mobile
Date of birth *
Email address
May PAN contact you via e-mail?	(PAN's privacy policy is available on our website or can be mailed to you by request)

By completing my application to become a member of PAN I assert the following *
I wish to become a member of Pagan Awareness Network Inc. (PAN) and support the aims of providing information about Paganism and networking within the Pagan community. I understand that by joining PAN. I agree to abide by the laws and by-laws of the association (available on request). I am over the age of 18.
I have read, understood and agree to the statements listed above

Sponsor Details (If you do not have a sponsor, leave this section blank)
Application sponsored by
Sponsor's member number

Payment Details *
I have sent $ as a

When you press the "Submit" button below you will be taken to the secure PayPal website to pay for your registration. Please ensure you continue through to the checkout.

Please mail us your cheque seperately and we will match your payment to your application

Please mail us your money order seperately and we will match your payment to your application

When you press the "Submit" button below you will be taken to our online credit card partners PayPal via the secure PayPal website to pay for your registration. Please ensure you continue through to the checkout.

Please list your direct deposit reference if you used one and we will match your payment to your application


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Direct Deposit Details
If you are paying your membership fee by direct deposit please use the details below. Bank: Westpac Banking Corporation Acc Name: Pagan Awareness Network Inc. BSB: 032206 Acc Number: 167670

Membership Costs
Single 12 Months: $40.00 Single 12 Months with proof of concession: $30.00 Family 12 Months: $70.00 3 and 5 year memberships do not attract a discount, however they are protected against any fee increases for their duration. Membership costs include GST.

Membership Type *

Membership Period *

Personal Details

By completing my application to become a member of PAN I assert the following *

Sponsor Details

Payment Details *

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