TESLA FORUM

Membership Application Form

www.teslaforum.com
Please fill this form and return it to Tesla Forum

Type of Membership [ ] Individual $30.00

(tick the relevant [ ] Student/Concessions $15.00
box): [ ] Corporate $120.00

Name:

Address:

Phone: Fax:

Cell: E-mail:

Date: ______________________

Signature: ______________________________________________

Payment Methods:

(1) Cheque and Money Order Payments: The cheque or Money Order should be made
to "Tesla Forum" and posted to Tesla Forum, P.O. Box 494, Dianella WA 6059,
Australia.

(2) Direct Bank Transfer: Transfers should be to the account detailed below. A copy of
the transfer receipt should be sent by ordinary mail, faxed or emailed.
Account Name: Tesla Forum
Branch Number: 066 125
Account Number: 1020 6647
Bank Name: Commonwealth Bank of Australia
Bank Address: Subiaco, Australia
All payments should be identifiable i.e. we will need a name and address (and phone
number would be nice) so tax invoices can be issued.

(3) Credit Card Payments: For payments by credit card (VISA and Mastercard),
please call our Treasurer on +61 (0)401 302 340

Note: Copy of the Tesla Forum Rules is available on your request. Note that the Rules
make the membership open to general public. A person or entity who wishes to become a
member must apply to the Committee in writing and sign the application form (you may
use this form).
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Tesla Forum of W.A. Inc.
A.B.N. 89 780 321 690
P.O. Box 494, Dianella WA 6059
E-mail: teslawa@hotmail.com or info@teslaforum.com
www.teslaforum.com