Please note: this form is only for purchasing a National Trust of Australia (Victoria) gift membership. If you would like to join another state or if you would like to membership for yourself please visit www.nationaltrust.org.au/join

Your State/Territory(Required)

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I would like to

Purchase a gift membership for someone

Who should we send the membership pack to?(Required)

To me (the gift giver)

To the Gift Recipient

Duration

Membership Category(Required)

Household

Family

Covers 2 adults and children under the age of 18. (Grandparents can substitute grandchildren for children).

Membership Price

$ 0.00

Gift giver details

These details are for the gift-giver. The gift recipient (member) details can be entered during the next step.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Member Details

Adult 1 Name(Required)

Title First Last

Email Address(Required)

Daytime Phone(Required)

Mobile Phone

Date of Birth (optional)

Household Details

Adult 2 Name(Required)

Prefix First Last

Date of Birth (optional)

Number of Children

Child 1 Name

First Last

Child 2 Name

First Last

Child 3 Name

First Last

Child 4 Name

First Last

Gift Recipient Address

Postal Address(Required)

Street Address or PO Box City State Post Code Country

Your Order Details

Your gift membership application is almost complete. Please review your order and enter your payment details below.

We'll send the gift membership pack to {Postal:55.1}, {Postal:55.3} {Postal:55.4} {Postal:55.5}.

We'll send the gift membership pack to {Postal:99.1}, {Postal:99.3} {Postal:99.4} {Postal:99.5}.

Your gift Membership

Membership Type:: {Membership Category:16}
Recipient Name:: {Your Name:30.3} {Your Name:30.6}
Recipient Email:: {Your Email Address:35}
Recipient: Phone:: {Daytime Phone:33}
Recipient Address:: {Postal:55.1},
{Postal:55.3} {Postal:55.4} {Postal:55.5}

Product		Price
Membership		$ {Membership Category:16:price}
Donation

	Total	{subtotal}

Billing Address(Required)

Same as Postal Address

Street Address City State / Province / Region ZIP / Postal Code Country

Credit Card(Required)

American Express

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Terms & Conditions NSW(Required)

I have read and accept the Membership Terms & Conditions

2024 Xmas Membership Form – Draft

Family

Gift giver details

Member Details

Household Details

Gift Recipient Address

Your Order Details

Your gift Membership

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