Direct Debit « Mensa Australia

This form is used to sign up for a direct debit for your annual subscriptions. This is made from your nominated bank account.

It will capture your subscription details which will be sent via email to the office.

The signing up occurs on Westpac's secure PayWay site, so Mensa does not need to capture or store your bank account details.

Since Westpac only allows a direct sign up with in a month of the first payment date, you enter your details for a variable payment.

Once the office receives confirmation of your signup, we will set the amount and the first payment to the 25th of the month in which your next renewal is due.

We will send you a reminder email a month before the payment is due. This is so you can ensure you have sufficient funds in your account. It is also an opportunity for you to cancel the direct debit if you want to.

Please allow at least 1 week before your payment is due for both sign up or cancellation.

The terms and conditions are displayed on the sign up page.

The amounts for the direct debit will automatically be adjusted as fees change over time.

Membership number *

Name *

email *

Subscriptions

Full rates - $99

Concession Rates - $49.50

Student rates - $49.50

Additional family member - $30

Second additional family member - $30

Third additional family member - $30

Subscriptions are for 1 year only. Check boxes that apply.
Concession holders and students will be required to enter further information below.
You can pay for up to 3 additional family members living at the same address. A box will appear where you enter their member numbers

Concession reference

Please supply Centrelink number, otherwise send explanatory email to memsec@mensa.org.au

Student reference

Tertiary students enter Institution and ID number
For Primary or secondary students please enter school name.
Pre-schoolers, just enter Pre-school.

Additional family members

Please enter Membership numbers or names

Total payment due $