Join Today - Australian Nursing and Midwifery Federation

Membership Application Form 2016 - 2017
to join the ANMF (SA Branch)
20 Good Reasons
NURSES, MIDWIVES & PERSONAL CARE ASSISTANTS
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$10m Professional Indemnity and Public Liability Insurance*
Journey accident cover*
Comprehensive legal and industrial advice
Access to pay rates and Enterprise Agreements
An industrial expert to check work-related statements
Free online CPD tutorials
Face-to-face CPD sessions
Professional Portfolio advice and assistance
Access to the ANMF (SA Branch) library
Opportunities to influence law and policy
Representation at Coronial and NMBA Inquiries
Bargaining for better working conditions
Expert advice and assistance with WH&S & WorkCover
Expert professional and industrial advice from our helpline
Email advisory service on professional and industrial issues
Member discounts on ANMF (SA Branch) holiday homes
Discounted childcare, health insurance and banking products
Internal Legal services on a range of matters
Member savings in 2000 locations
Monthly journals and e-Bulletins
Join
Today
visit
anmfsa.org.au
* Details, including exclusions and limitations are available
on the ANMF (SA Branch) website.
ANMF (SA BRANCH) MEMBERSHIP FEES
Membership Subscription July 2016 - June 2017 (GST included)
Category
Fortnightly
Monthly credit
Quarterly
Yearly by
direct debit
card/direct debit
credit card
Invoice*
REGISTERED NURSE
OVER 24 HOURS
$31.50
$68.30
$188.90
$769.00
17 – 24 HOURS
$23.60
$51.20
$142.20
$582.30
16 HOURS OR LESS
$15.80
$34.20
$95.50
$395.60
ENROLLED NURSE
OVER 24 HOURS
$22.10
$47.80
$132.90
$545.00
17 – 24 HOURS
$18.90
$41.00
$114.20
$470.30
16 HOURS OR LESS
$12.60
$27.30
$76.90
$320.90
PERSONAL CARE ASSISTANT
OVER 24 HOURS
$18.90
$41.00
$114.20
$470.30
17 – 24 HOURS
$15.70
$34.20
$95.50
$395.60
16 HOURS OR LESS
$11.00
$23.90
$67.60
$283.60
$11.00
$23.90
$67.60
$283.60
WORKING UNDERGRADUATES
AIN/AIM
Please note, if you are presently working as a nurse, midwife or personal care assistant you must join the ANMF (SA Branch) as a full member.
*A $20 discount applies on yearly, invoiced payments (if paid by the due date).
For more information telephone:
8334 1902
Authorised by Adj Assoc Professor Elizabeth Dabars AM, CEO / Secretary, ANMF (SA Branch)
ANMF (SA Branch) ABN 95 969 485 175, 191 Torrens Road, Ridleyton, SA 5008
ANMF (SA Branch) membership fees
are fully tax deductible and your cover
starts the day you join.
Professional, legal and industrial
advice and representation is only
provided to those who are full
financial (working category) ANMF
(SA Branch) members at the time the
instance for which they are seeking
assistance occurs.
Membership details
Title (circle)
Ms
Miss
Mrs
Dr
Mr
/
Date of birth
/
Recruited by
First name(s)
Surname
Previous surname
Ethnicity
Suburb
Address
Home phone
PCode
Mobile
Work Phone
Email
Ward / Unit
Worksite/Employer
Category (tick) EN
RN
NP
Qualification (tick) RN + Midwife
Midwife
AIN
RN Mental Health
Hours/week
AIM
Personal Care Assistant
Midwife
Academic / Lecturer
IMPORTANT: All new members must sign both sections.
Section 1: Federal Organisation Membership
I apply for admission to membership of the Australian Nursing and Midwifery Federation ABN 41 816 898 298, an
organisation registered pursuant to the Fair Work Act 2009 (Cth). I agree that, when admitted, I will observe the
rules of the union* as amended from time to time and appoint the ANMF as my bargaining agent.
Section 2: State Union Membership
I apply for admission to membership of the Australian Nursing and Midwifery Federation (SA Branch) ABN 95 969
485 175, an organisation registered pursuant to the Fair Work Act 1994 (SA). I agree that, when admitted, I will
observe the rules of the union* as amended from time to time and appoint the ANMF as my bargaining agent.
Please choose one of the options below.
PCA Qualification _________________________
Signature:
Date:
Signature:
Date:
* Resignation: Members intending to resign are required to give 14 days written notice and remain financial during this period.
Option 1: Monthly/Fortnightly Direct Debit From Bank Account or Credit Union
I/We _______________________________________________ Date ______/______/______ in accordance with the terms and conditions contained in the Direct Debit Service Agreement hereby authorise the
Australian Nursing and Midwifery Federation User 01593 to debit for the purpose of ANMF membership subscriptions, my nominated account with any amount which the Debit User is entitled to charge
me/us through the Bulk Electronic Clearing System.
Monthly
debit
Fortnightly
debit
Next
pay date
/
/
Account
number
BSB
number
Name of
Financial
Institution
Name of Account
(Please insert exact name
eg WP SMITH)
By signing this Direct Debit Request, you acknowledge having read and understood the terms and
conditions governing the debit arrangements between you and us as set out in the Direct Debit
Request and Service Agreement. Please ensure account details are recorded correctly and the form
has been signed by authorised signatories.
Signature of
customer(s)
Option 2: Monthly/Quarterly Credit Card Authorisation
Monthly debit
Quarterly debit
I hereby authorise the ANMF (SA Branch) to charge my credit card automatically upon receipt of this authorisation for subscription up to the end of the current financial month/
quarter and henceforth on the first working day of each month/quarter. In the event of changes to subscription rates I authorise the ANMF (SA Branch) to alter the amount from
the appropriate date in accordance with such changes.
Mastercard
Cardholder’s
name
Visa
Card no.
Cardholder’s
signature
Expiry
date
Please enclose payment with membership form
Option 3: Yearly Payment
Cheque
Money Order
Credit Card
or complete a one off credit card payment below
if credit card, fill
out details below
Cardholder’s
signature
Cardholder’s
name
Mastercard
Visa
Expiry
date
Card no.
Return to: ANMF (SA Branch), Reply Paid 861, Regency Park BC, SA 5942
Phone: 8334 1900
Toll free 1800 809 642
www.anmfsa.org.au
Privacy policy: The ANMF (SA Branch) collects personal information from members in the performance of our role in representing the industrial and professional
interests of members. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected
under law and can only be released to someone else where the law requires or where you give permission. For full privacy policy details, visit www.anmfsa.org.au/policy
Office use only
Member no:
Receipt #
Paid $
Notes: