tes Online Membership Application Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Title Given Name Surname Gender* Male Female Prefer not to answer Company: If Corporate ApplicationDate* Address* Street Address City Suburb State Territory Post Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email* Phone/MobileMembership*Enter Membership Option. Annual Recurring available for all memberships. $50 Per Year Jan~Dec $300 Life Membership (Over 60) $500 Corporate Membership $100 Family (2 Parents or Grandparents + 1 Child) $60 Family (1 Parents or Grandparent + 1 Child) $110 Family (2 Parents or Grandparents + 2 Children) $70 Family (1 Parents or Grandparent + 2 Children) $120 Family (2+ Parents or Grandparents + 3+ Children) $80 Family (1 Parent or Grandparent + 3 Children) $15 Junior U18 Pay By EFT Bendio Bank (BSB 633-000 A/C 162344949) Pay Via Credit Card or PayPal (Via our PayPay Page) An Extra Donation to OSSA Extra Donation Amount - Amounts over $2 are tax deductible.Would you like to recieve invites to our fortnightly meetings? (Via Zoom or at the Mission to Seafarers - Melbourne)* Yes No Able to Help OSSA?Please indicate in Box, more than one can be selected.Exhibitions and EventsAdmin / IT / Social MediaGrants / FundraisingNewsletterCollection / CataloguingMembershipGovernment Corporate LiaisonSchool PromotionsOther - enter in box below.Not Right NowOtherHow did you hear about OSSA* Industry Facebook Instagram LinkedIn Friend Other Please let us know how you heard about OSSAAgreement and Signature* By signing I agree to abide by the Constitution of Offshore and Specialist Ships Australia, for my contact details to be published in the Member area of the Website (password protected). www.ossa.org.au and that my membership donation will support our Vision. Maritime Experience I have have previous Maritime experience, seagoing or shore based. If so please provide us with some brief details.
