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You will receive a confirmation email from membership@breaze.org.au after submitting this form

Please check your spam folder in case the BREAZE emails are being mistaken for spam by your system (Big Pond users in particular). How to Allow BREAZE emails      Newsletter subscriptions are FREE!

February 2010

Silent Registrations - if you get a white screen of nothing instead of "Registration Complete!" and no email - please email jill@breaze.org.au Your registration details have been saved, it is just that nobody has been notified.
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This Field IS NOT visible on profile Information for: Title : Optional title; eg Mr, Ms, Dr, Rev
* This Field is required This Field IS NOT visible on profile Information for: First Name : Please enter your real first name.
* This Field is required This Field IS NOT visible on profile Information for: Last Name : Please enter your real last name.
* This Field is required This Field IS visible on profile Information for: Username : Please enter a valid username. No spaces, at least 3 characters and contain 0-9,a-z,A-Z
* This Field is required This Field IS NOT visible on profile Information for: Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required This Field IS NOT visible on profile Information for: Verify Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required This Field IS NOT visible on profile Information for: Email : <p>Please enter your email address.&nbsp;</p> <p>Check the article "How to allow BREAZE emails" and set you spam settings to allow emails from breaze.org.au</p>
* This Field is required This Field IS NOT visible on profile Information for: Phone Number : <p>Please tell us your home phone number - it will not be publicly available.</p>

Subscriber (Newsletter Only) - free
BREAZE has a number of Financial Memberships available to suit families, individuals, businesses and other organisations.

Fee Structure
* This Field is required This Field IS NOT visible on profile Information for: Membership Type : <p>If you need to pay us for your membership, please use one of the payment methods described below</p>
Please add me to the BREAZE email list!
BREAZE Newsletter
Please continue if you are applying for paid membership. Having your contact details will assist the Membership team. Don't forget the Register button - right down the bottom!

Please provide a phone number - if your email address stops working, we will need a way to contact you to sort it out!
This Field IS NOT visible on profile Information for: Payment Type : Please choose your type of payment
Direct Deposit to:

BREAZE
Bendigo Bank
BSB Number: 633-000
Account Number: 130380033
Direct Deposit reference:
When you are making your payment, please use your first initial and last name as a reference.
Once you have made  your payment, please email Treasurer, Joe Boin (joe@breaze.org.au) the reciept number so that we can match up your payment with our records.

Pay Pal

If you wish to pay by Paypal or use your credit card, go to the Payment Options page to get access to the Paypal links. Make sure you click the REGISTER button at the bottom before you leave here though!
Interested in helping out? Let us know what skills/resources you can offer, and fill in the boxes below:
This Field IS NOT visible on profile Information for: Tick for Yes! : Yes you can help out!
This Field IS NOT visible on profile Information for: Member Skills : What skills or resources can you offer as part of the BREAZE community?
This Field IS NOT visible on profile Information for: Address : Enter your postal address, and street address if it is different.
This Field IS NOT visible on profile Information for: Town or Suburb : Please enter the name of your town or suburb.
This Field IS NOT visible on profile Information for: Postcode : Please enter your post code
This Field IS NOT visible on profile Information for: Mobile : Please enter your mobile phone number
This Field IS NOT visible on profile Information for: Work Phone Number : - leave your work phone if you are able to be contacted at work
 
* This Field is required Required field | This Field IS visible on profile Field visible on your profile | This Field IS NOT visible on profile Field not visible on profile | Information for: ? : Field description: Move mouse over icon Information: Point mouse to icon


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