Pioneers SA Suite 4, Level 2, Stafford House, 25 Leigh Street, ADELAIDE, SA 5000 p.: 08 8231 5055, m.: 0409 043 264, e.: membership@pioneerssa.org.au
OFFICE USE ONLY
Date received:	[DD] / [MM] / [YYYY]
Member No:	[NNNN]
To make an application for Life, Pioneer or Associate membership please complete the details below. Email it or print and post the form to the Membership Officer at Pioneers SA (membership@pioneerssa.org.au) and make the payment (see page 2). The application will be reviewed to ensure it meets the eligibility criteria, when accepted by Council you will be sent information about your membership.
To fill in this form, click on the red text in a field and type the information required. Click in the box you want to mark with an “x”, to remove the “x” click again. Required fields are marked *
Category of membership you are applying for (please “x” applicable)	x
IMPORTANT: When applying for two Pioneer memberships or a Pioneer membership with an Associate membership, two application forms must be completed, one for each person.	Life Member	☐
Pioneer Member	☐
Associate Member	☐
Mr	☐	Miss	☐	Mrs	☐	Ms	☐	Dr	☐	Other:
[Other]
*Full name:	[Click & type your full name here]	*Preferred name:	[Type your preferred name here]
*Date of Birth:	[DD] / [MM] / [YYYY]
See “1. Shared Membership” on page 2.	Shared membership with (name):	[Click & type the name here]
Applicant’s Postal Address
*Number & Street:	[Type number & Street]	*Suburb:	[Type Suburb]
*State:	[Type the State]	*Country:	[Type the Country]	*Post code:	[Postcode]
Phone (Home):	[Type your phone No.]	*Phone (Mobile):	[Type your mobile No.]
*Email:	[Type your email Address]
*What is your preferred delivery method for Journal “The Pioneer”?	By Post	☐	By email	☐
(paper copy)	(electronic copy)
Applicant’s Pioneer (Primary) Ancestor (Not required for an Associate membership) *Please complete the separately supplied “Pioneer Details” form The person must have arrived in South Australia on or before 28th December 1846 either by ship or overland.
Applicant Checklist (Please checkoff you have included all application documents)
Completed all required fields on the application form	☐
Completed the pedigree chart using the Pioneers SA chart	☐
Completed the Pioneer Details form	☐
Applicant’s Signature and Date (Digital signature otherwise leave the signature blank and just add the date.)
Signature of Applicant:	*Date:	[DD] / [MM] / [YYYY]
Attachments
Life and Pioneer applicants, please attach evidence showing your direct family line from you to your earliest arrival in SA, named above. See “5. Pedigree Chart” on page 2, for the full requirement.
How did you learn about Pioneers SA (x)	Friend	☐	Facebook	☐	Local History Group	☐
Other	☐	Please specify	[Type how you learned about Pioneers SA]

Shared Membership

A shared membership is where two partner Members or a Member and Associate Member and agree to receive a shared copy of the Journal for a discounted membership fee. When joining a separate membership application must be completed for each person.

Member Contributions

The membership period is twelve months from July 1st to June 30th. There is a one off $15 joining fee for each new Life, Pioneer or Associate membership.

Full Year Membership

$65.00 p.a. each - Pioneer & Associate membership

$110.00 p.a. - For two members residing at the same address (“The Pioneer” journal is a shared copy).

Half Year Membership (if you join after December 31st)

$30.00 p.a. each - Pioneer & Associate membership

$47.00 p.a. - For two members residing at the same address (“The Pioneer” journal is a shared copy).

Life Membership
18 to 49 years	$1,300	70 to 79 years	$740
50 to 59 years	$1100	80 years and over	$560
60 to 69 years	$930

Payment Methods

Payment may be made using one of the three options below. For “Direct Credit”, EFT payments, please include your name and the Pioneers SA email address in the “email recipient of payment” box, if your bank provides for it.

CREDIT/DEBIT CARD PREFERRED Pay in person at Pioneers SA or by phone using your Credit Card.	DIRECT CREDIT (EFT) PREFERRED Account: Pioneers SA BSB No.: 105900 Account No.: 950067040 Description: Your name(s)	CASH Complete payment slip, at the bottom of the page. Bring the cash payment into Pioneers SA.

Primary Ancestor

Is that adult person or couple that was/were the earliest arrival. This is the requirement for your Pioneer membership. Information about your other ancestors that arrived within the qualifying period is not mandatory, but will add to the Pioneers SA ancestor database, and could provide a link to other members with the same ancestor

Pedigree Chart.

Pioneers SA ask that your chart is completed on the electronic copy of the Excel Pioneers SA Pedigree Chart available on the Pioneers SA website or forwarded to you via email. The completed chart can be emailed to Pioneers SA, membership@pioneerssa.org.au.

If you are unable to complete it electronically, please print the .PDF version and complete it by hand. Your completed handwritten application and chart may be scanned and emailed to the Pioneers SA office, or where this is not possible, a hard copy posted to Pioneers SA.

The chart must show the continuous direct line of descendants from your pioneer ancestor(s) to you. The birth, marriage & death details and the source information that substantiates it must be provided for all direct descendants. Please include all the information you have as this will prove your connection to your Primary Pioneer Ancestor(s).

Research Links

The links below will assist you in your research, you may also come into Pioneers SA and use the research facilities available in there to carry out your research.

Shipping arrival data:	Early South Australian Birth Deaths and Marriages:
http://www.familyhistorysa.org/shipping/passengerlists.html	http://www.familyhistorysa.org/births-marriages-deaths/births.html
South Australian Birth Deaths and Marriages:	http://www.familyhistorysa.org/births-marriages-deaths/marriages.html
https://www.genealogysa.org.au/resources/online-database-search	http://www.familyhistorysa.org/births-marriages-deaths/deaths.html
ONLY include the section below if paying by cash or cheque

Name	Contribution ($)	Joining Fee ($)	Sub-Total ($)
$
If paying a shared membership, please include both members’ names but only record the amount of the contribution and sub-total in the second line. $	TOTAL ($)