I/We are filling this in for: PersonalBusiness First Name(s)*Surname*Email addressMember NumberPhoneFree Reformed Church Membership*ArmadaleBaldivisBunburyBusseltonByfordDarling DownsKelmscottMelvilleMt NasuraMundijongRockinghamSouthern RiverAlbanyWest AlbanyCompany/Entity Name(s)*Business Owner NameEmail*Phone*Street addressSuburbStateWATASQLDNTACTVICNSWSAPostcodeI/We are committing to a Voluntary Commitment:$260 per year ($5 per week)$2,600 per year ($50 per week)$520 per year ($10 per week)$5,200 per year ($100 per week)$1,040 per year ($20 per week)Other Amount (Per Year):I/We will pay this:Frequency of Payment*WeeklyFornightlyMonthlyYearly (in advance)My payments will commencePlease Note:Please ensure your voluntary increased commitment is paid to the Building Fund account: BSB 036-224 Account: 174944Please include your member number in your payment description.If you are submitting this form under your business name, a separate account will be established.Following the submission of your application, you will receive an email from the FRSA finance team with an updated statement reflecting your voluntary increased commitment.Signed*Date*