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
We are unable to process your online application unless you provide us with an email address. We need this to verify users and for security purposes.

Driver Licence Number

Passport Number

Expiry Date

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.

I understand my membership fee of $37 Individual / $54 Family will be charged to the account I have nominated. To avoid any interruption to my services, I understand the annual membership fee will be renewed automatically each year and that I will receive at least 14 days advance notice of the renewal fee which will be automatically charged to the nominated card.

I understand that if I cancel my membership within 30 days after my membership fee is debited from my account, I will receive a full refund of my membership fee. I understand that after this 30 day period, no refund will be available.

I consent to the use of my personal information for the purpose of providing membership and related services, which includes sending me information on any new membership benefits or services that Secure Sentinel may provide. I consent to the disclosure of personal information to and obtaining information from third parties such as card issuers, mobile phone service providers and mailing agents for this purpose. Where I provide personal information on behalf of others, I confirm that I am authorised to give these consents on behalf of those people.

I agree to the Secure Sentinel Terms and Conditions, which can be accessed from the Secure Sentinel website.

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 Terms and Conditions.