Application Form
Lifestyle Advantage Package
The Lifestyle Advantage Annual Membership Fee is $39.95 (Normally $69.90)
Please complete separate form for each application
Fax to 1300 139 556
Post to SMA MEMBERBenefits P.O. Box 2200 Mornington Vic 3931
Please provide the following details.
Personal Details
Mr/Mrs/Ms
Full Name
Date of Birth
Address
City/Suburb/Town
State
Post Code
Occupation
Phone (Home)
Phone (Business)
Mobile Phone
Email
Payment Details
Please select card type by placing a tick or a "Y" in the relevant box:
Mastercard
Visa
Bankcard
Name on Card
Card Number
Expiry Date
I authorise you to charge the amount of to the nominated card.
Signature
Alternatively, send a cheque or money order made payable to MEMBERBenefits P.O. Box 2200 Mornington Vic 3931
All information will be treated with strictest confidence
