RCOA Membership Form
* I am:  A Former or Retired Customs Officer or
a 'Friend' of the RCOA

* Given Name: 
* Family Name: 
Partner's Given Name: 
Partner's Family Name:  (ONLY if different)
* Main Email: 
Partner's Email:  (If required)
Mobile Phone: 
Partner's Mobile Phone: 
Other/Home Phone: 
* Address (No. & Street): 
Additional Address Line:  (If required)
* Address (Suburb): 
* Postcode: 
* State: 
Note:  Our Newsletter includes a segment for publication of members and spouses birth and wedding anniversary dates (day & month only printed) If you would like to share this detail with other members please complete the following (include year if you wish for our records ONLY)
Member Birthdate: 
Partner Birthdate: 
Wedding Date: 
Receive Newsletter via:  Email (Preferred option) Post
Additional information or comment: 

Note:  RCOA Membership is currently $10 per year (due on the 1st of January each year). Please forward $10 or a multiple of, for more than one year, via one of the following methods;-
I will send payment via:  EFT (Preferred option) Cheque AMO Cash
* For (Number of) Years:  Select '0' if no payment required (eg. 'Updating' information)
All fields marked with * must be completed