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PERSONAL DETAILS

TITLE(Required)

SURNAME(Required)

FIRST NAME/S(Required)

KNOWN NAME

STREET ADDRESS(Required)

SUBURB(Required)

STATE(Required)

POSTCODE(Required)

POSTAL ADDRESS

MOBILE(Required)

PRIVATE EMAIL(Required)

DATE OF BIRTH(Required)

DD slash MM slash YYYY

QFR WORK DETAILS

QFR EMPLOYEE NO.(Required)

REGION(Required)

QFR STATION(Required)

RANK(Required)

EMPLOYEE TYPE(Required)

QFR RECRUIT COURSE NO.

SIGNATURE(Required)

By typing your full name you acknowledge that you have signed this form.

DATE(Required)

DD slash MM slash YYYY

DIRECT DEBIT DETAILS

NOTE: Membership Fees are payable yearly, half yearly and quarterly in advance OR by direct debit through your bank account or credit card.

FORTNIGHTLY (Thursday)

Full time

$37.00

Part Time/Casual Firecom

$28.00

MONTHLY (2nd Thursday)

Full time

$80.17

Part Time/Casual Firecom

$60.67

Auxiliary

$18.50

QUARTERLY (2nd Thursday Jan, Apr, Jul, Oct)

Full time

$240.50

Part Time/Casual Firecom

$182.00

Auxiliary

$55.50

HALF YEARLY (2nd Thursday Jan, July)

Full time

$481.00

Part Time/Casual Firecom

$364.00

Auxiliary

$111.00

ANNUALLY (2nd Thursday July)

Full time

$962.00

Part Time/Casual Firecom

$728.00

Auxiliary

$222.00

PAYMENT

Request and Authority to Debit/Charge the Account named below to pay QPFU subscriptions and/or levies I authorise and request that the amount payable for subscriptions and /or levies (as varied from time to time) which the responsible officer of the QPFU certifies as the amount due pursuant to the relevant rules be paid from my account by either direct debit or credit card as indicated by me through the ‘Bulk Electronic Clearing system (BECS)’.

DIRECT DEBIT BANK(Required)

I authorise and request the QPFU (ID 404605) to debit my account through ‘Bulk Electronic Clearing System (BECS)’.

The terms and conditions of the Direct Debit Request Service Agreement shall apply.

Financial Institution Name

Account Name

BSB

Account No.

By signing/typing your full name on this Direct Debit Request you acknowledge having read and understand the Direct Debit/Credit Card Fee Request Service Agreement which is available on our website at www.qpfu.com.au.

Signature

By typing your full name you acknowledge that you have signed this form.

Date

DD slash MM slash YYYY

DIRECT DEBIT CREDIT CARD(Required)

I hereby authorise and request the QPFU to charge my credit card account.

This authority shall stand until I notify the QPFU otherwise in writing.

Name on Card

Card Type

Mastercard

Visa

Card No

Automatic Debit

Expiry Date

DD slash MM slash YYYY

Signature

By typing your full name you acknowledge that you have signed this form.

Date

DD slash MM slash YYYY

Joining in Dispute Policy(Required)

I acknowledge that I have read and accept the QPFU Joining in Dispute Policy.

Untitled

Number

Comments

This field is for validation purposes and should be left unchanged.

NEW MEMBER FORM

PERSONAL DETAILS

QFR WORK DETAILS

DIRECT DEBIT DETAILS

PAYMENT

Contact

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Industrial Relations

Join Today

NEW MEMBER FORM

PERSONAL DETAILS

QFR WORK DETAILS

DIRECT DEBIT DETAILS

PAYMENT

Contact

Members

Industrial Relations

Login to Members Portal