Membership

Fill in the form below to submit your membership application. You'll be taken through to a secure payment area, and once paid - we'll finalise and send out your membership card.

Application

Items marked with an * must be completed

Joining / Renewing? *	New Member Renewing Member Previous Member
Membership Number *
Membership Type *	General 1 year $12 General 3 years $32 General 5 years $48 Student 1 year $6 No additional cards with Student Memberships
Title	MrMrsMsMiss
First Name *
Last Name *
Date of Birth
Address *
Suburb *
State *
Postcode *
Postal Address (if different from above)
Postal Suburb
Postal State
Postal Postcode
Email		Please provide your email address to receive special offers from UFS Pharmacies.
Mobile Number
Home Phone Number
Work Phone Number
Additional family member # 1 (same household)		Do they require a card?	No Yes
Additional family member # 2 (same household)		Do they require a card?	No Yes
Additional family member # 3 (same household)		Do they require a card?	No Yes
Would you recommend Bendigo UFS to your family and friends?	Yes No
Comments
Nominate your school, club or organisation and 50% of your membership fee will be donated back to that group. School Club or organisation I do not wish to nominate any school, club or organisation School:   Axedale Primary School Bendigo North Primary School Bendigo Senior Secondary College Bendigo South East College Bendigo Special Development School Camp Hill Primary School Comet Hill Primary School Dr. Harry Little Memorial Pre School Eppalock Primary School Holy Rosary Primary School Huntly Primary School Kalianna Special School Kennington Primary School Lockwood Primary School Lockwood Sth Primary School Maiden Gully Primary School Marong Pre School Marong Primary School North Bendigo Pre School Quarry Hill Primary School Specimen Hill Primary School Spring Gully Primary School St. Francis of the Fields Primary School St. Joseph's Primary School St. Kilian's Primary School St. Peter's Primary School St. Therese's Primary School Strathfieldsaye Primary School Club:   Atisha Buddist Centre Bendigo Animal Welfare & Community Services Bendigo Autism Asperger Group Bendigo Breast Cancer Support Services Network Bendigo East Baseball Club Bendigo Scleroderma Support Group Bendigo Squash Club Inc. Dragon City Derby Dolls Inc. Golden Square Football & Netball Club Loddon Mallee Kids- Premature Babies Support Group Maiden Gully Fire Brigade Maiden Gully Junior Football Club Maiden Gully Neighbourhood Watch Midland Amateur Radio Club National Seniors - Bendigo & District Quest Equine Welfare Righteous Pups Australia Senjuns Hockey Club Sing Australia Bendigo St Luke's Anglicare State Emergency Service Victoria - Bendigo Unit Strathfieldsaye Bowls Club Strathfieldsaye Neighbourhood Watch The Otis Foundation Valkyrie Care Group
I do not wish to receive notification of special offers and promotional events   I wish to receive notification of Annual General Meetings   I wish to receive the Annual Report