NEW MEMBER APPLICATION

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New Membership Application Form

First Name

Date of Birth

Home Phone

Last Name

Community Group Name

Mobile Number

Address

State

Suburb

Postcode

Email

I am interested in becoming a:

Volunteer

Board Member

Tutor

I wish to become a member of the Mt Beauty Neighbourhood Centre Inc. and have provided the appropriate membership fee.

I declare that the above personal information is true and correct

I want to subscribe to the newsletter.

Choose Membership Fee *

Individual - AU$10

Individual Concession - AU$5

5-year Individual - AU$45

Community** - AU$25

Small Business - AU$100

Corporate - AU$500

Membership Year

**Community Membership fee Includes up to $20 of Printing and discounted venue hire $10 per hour or session

Your Signature

Thanks for submitting!

Receipt Number

Board Approval

Membership No.

Acknowledgment of Country

We acknowledge that we are on traditional lands of the Dhudhuroa and Yaitmathang clans. We offer our respect to the Elders of these traditional lands and, through them, to all Aboriginal and Torres Strait Islander people.

1 Tennis Court Avenue, Mount Beauty. Victoria. 3699

Ph: 03 5754 1166

Message: 0439 073 699

info@mountbeauty.org.au

Open 10am - 3pm

Monday to Friday (excluding Public Holidays)

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Mount Beauty Neighbourhood Centre Inc.

Acknowledges the support of the Victorian Government.

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