`[Cities Logo][Cities Name]` Membership Registration

Are you a person of Telugu origin ?*

Yes No

Member Type*

Free Membership Annual(Single) - $1 AUD Annual(Family) - $2 AUD Life-Time - $3 AUD

Payment Type*

PayID:

+61 000 000 001

Bank Transfer Details

Account Name: Navya Andhra Telugu Association

BSB: 012-936

Account Number: 397815696

Reference: Please include your full name as reference

First Name: * Spouse First Name:

Last Name: * Spouse Last Name:

Name of the children	( Age )	Skills / Interests	Add/Remove

Address: *

State: * City: * Postcode: *

Member's Email: * Spouse's Email:

Member's Profession: Spouse's Profession:

Member's Phone:* Spouse's Phone:

Would you like to volunteer in the future Nata events? Yes No

Interests:

I agree to the terms and conditions.

Payment Amount: $---.--