Membership Checkout

Membership Information

You have selected the Individual membership level.

Please note, our membership billing period ends on the 30th of June. Renewal reminders will be emailed from 1 June.

The price for membership is $66.00 now.

Membership expires on June 30, 2027.

Do you have a discount code?

Account Information

Username

Password

Confirm Password

Hint: The password should be at least twelve characters long. To make it stronger, use upper and lower case letters, numbers, and symbols like ! " ? $ % ^ & ).

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

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Make a Gift

Donation Amount

Make a donation to support our charity Palliative Care SA.

Individual Account Information - What do do

Please note what details you should include in your account information above.

Usernames —

Please use your first and last name combined with no spaces as your username e.g. JaneDoe

Your Details

Salutation

First Name

Last Name

Address

Suburb

State

Postcode

Phone Number

Employment Details

Are you currently employed?

Yes

If you are currently unemployed, please enter N/A into the fields below —

Name of the organisation you work for

What is your role at this organisation?

How did you hear about PCSA?

Please select the best option

If other, please specify

Terms & Conditions

Please note, membership will require approval - this can take up to 2 weeks.

I have read and agree to the objectives of the organisation.

I have access to the PCSA Constitution and I understand that my membership can be revoked at any time if I operate outside of the values of the organisation.

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