MAKO- Single Membership Form

Name: __________________________________________ D.O.B: _______________

Residential Address:(you must supply a residential address- P.O Box alone is unacceptable)
 __________________________________________________________________________________

Mailing Address: (if different from above)
 __________________________________________________________________________________

Town/ Suburb:  __________________________ State:  _______ Post Code:   _______

H/ Phone:  ______________ Mob:  _________________ e-mail:   _________________

Drivers Lic No:  _________________ State:  ______________ Exp:   ______________

Occupation/ Skills:
 _______________________________________________________________________

Reason for Joining:
 _______________________________________________________________________

FREE MEMBERSHIP- Membership includes: 20 MAKO awareness/ prevention flyers/ a copy of the "2011 MAKO/Files" (State list only - so if you are in "Victoria", you will receive a copy of the 2011 "Victorian" MAKO/Files), online updates + other useful information to help keep you and your family/ children safer..

$50 (AU) MEMBERSHIP (Optional) Membership includes: 100 MAKO Awareness/ prevention flyers/ a copy of the "2011 MAKO/Files" (Listing over 2200 paedophiles/ sex offenders "Australia wide") online updates + other useful information to help keep you and your family/ children safer..
Choose Method of Payment  
Cash Cheque Money order

Applicant: I agree that the information I provided on this form is true and correct..

Name: __________________________________

Signed: _________________________________

Dated: ____________

WARNING
When you apply to join MAKO, you give MAKO Management the right to conduct a background check for sexual related-child abuse offences..

Make A Donation Today- Donations are welcome at any time. Post membership form to MAKO - P.O Box 299, Belmont, VIC (3216).
You must be at least 18 years of age to join MAKO, unless in a family membership situation.

Prevention Must Be The Priority
www.mako.org.au

© MAKO 2010