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Australian Capital TerritoryGift Membership

Gift Membership

1Select Membership

2Member Details

3Confirm & Pay

Order Details
I would like to purchase a gift membership for*
Please note: this form is only for purchasing a gift membership to the National Trust in ACT, NSW or Victoria. If you would like to join another state please visit www.nationaltrust.org.au/join
Duration
Select a membership category*
- Individual
- Individual Senior
- Individual Concession
- Household
- Household Senior
- Household Concession
Select a membership category*
- Individual
- Individual Senior
- Individual Concession
- Household
- Household Senior
- Household Concession
Membership Total
$ 0.00
Who should we send the membership pack to?
- To me (the gift giver)
- To the Gift Recipient
Gift giver details
These details are for the gift-giver. The gift recipient (member) details can be entered during the next step.
Name*
First Last
Email*

A payment confirmation will be sent to this email address.
Phone*
We'll call you on this number if there are any issues processing this gift membership.
Address*
Street Address City State Post Code Country
We'll send the gift membership pack to this address.

Member Details
These details are the gift recipient's details (the new Member/s).
Name*
Title First Name Last Name
Email Address*
Daytime Phone*
Mobile Phone
Date of Birth (optional)
Additional Information
Adult 2 Name*
Title (Adult 2) First Name (Adult 2) Last Name (Adult 2)
Date of Birth (optional)
Postal Address
Address*
Street Address City State Post Code Country

Your Order Details
Your membership application is almost complete. Please review your order and enter your payment details below.
{all_fields}
Billing Address
Same as previous
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card Details
Credit Card*
American Express
MasterCard
Visa
Supported Credit Cards: American Express, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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Phone
This field is for validation purposes and should be left unchanged.

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