Your Name (please print) __________________________________________________________________________Your e-mail address  _____________________________________________________________________________Your postal address  _____________________________________________________________________________ If you are subscribing on behalf of someone else as a gift please provide name of recipient for our Summit Scroll (please print)  _______________________________________________________________________Please provide their e-mail address __________________________________________________________________Their postal address ______________________________________________________________________________

Please tick appropriate category:
SUMMIT CIRCLE MEMBERSHIP $8850 inclusive of GST
SUMMIT TEAM MEMBERSHIP $885 inclusive of GST
SUMMIT SUPPORTER MEMBERSHIP $88.50 inclusive of GST
Amounts above the level of each of the above categories will be gratefully accepted, and if this applies to you please print amount here:$______________(inclusive of GST) Total with Membership and Donation $______________(incl. GST)METHODS OF PAYMENT:BY CHEQUE: Please make cheque payable to:THE AUSTRALIAN YOUNG ADVENTURERS Post to The Australian Young Adventurers PO Box 157 Emu Plains NSW 2750BY CREDIT CARD: Please debit my credit card. Please tick applicable card: Visa MasterCard Bankcard
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Expiry Date: / (example 06/05)Name on card (please print) ________________________________________________________________________
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Thanks for your support. I’m looking forward to our amazing journey together.
Christopher!