PRIORITY MEMBERSHIP APPLICATION

When you complete the form below you will be sent the Secure Sentinel Welcome Letter with specific advice on how to register and the link with the full Terms and Conditions of your membership.
Date of Application	Campaign Code
Title	First Name(s)	Middle Initial	Surname
MrMrsMissMs Dr
Your Address

Suburb/Town	State	Postcode
	ACTNSWNTQLDSATAS VICWA

Telephone Home	Business	Mobile
Email Address

Your Security Details	Date of Birth	Mother's Maiden Name
(For ID purposes only)
Please charge my	Mastercard   Visa   Diners   American Express

Card Number

Expiry date

please note we will not accept payment by cheque.

Level of Cover

Individual Member $37

Family Member $54

Please complete family details below for full protection.

FAMILY / HOUSEHOLD MEMBERSHIP includes your partner / spouse, children still living at home or house mates.
Title	First Name	Middle Initial	Surname	DOB	Relationship	Mother's Maiden Name
Mr Mrs Miss Ms Dr
Mr Mrs Miss Ms Dr
Mr Mrs Miss Ms Dr
Mr Mrs Miss Ms Dr

You will receive a welcome letter from Secure Sentinel within 10 business days. It will include a checklist and form to complete in order to register your personal belongings and make the most of your membership. Please confirm that you accept.

I have read the above detailed Terms and Conditions to the Applicant.