logo


Enrolment as a member of  EC-Menz incorporated

Please complete the boxes below and click on "submit form"
Within the next few days, you will receive an acknowlegement of your membership
application and payment details

(you must provide a valid email address in the form so we can respond!)

Enrolment fees:

In full-time employment - $20.00 p.a.
In Part-time employment, unwaged or in training - $5.00 p.a.

(please note: EC-MENz  must be informed of any change to your email address for you to retain full benefits of membership)

By Submitting this form I agree to abide by the EC-MENz inc Rules
          
Important!
Our membership form is occasionally misbehaving.
If on submitting this form you get taken to an "error page"...
to join/renew please send the details required in the form directly to Gerald Jacobson <gerald.c.jacobson@gmail.com>
with the email header: EC-MENz Membership


Forename
Surname
Address
Centre or Workplace
Job Description
Home email - required
Work email-optional
Home phone
Work phone-optiona
Cell phone
e-transferChequeOther
If ..Other; -please specify