RENEW MEMBERSHIP | MTBNCI

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Membership Renewal Form

Please fill in your name and any other changes of your personal details.

First Name

Last Name

Community Group Name

Email

Phone Number

Street Address

State

Suburb

Postcode

Membership Year

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

**Community Membership fee includes up to $20 of Printing and discounted venue hire ($10 per hour or session).

I would like to subscribe to the newsletter.

Your Signature

Thanks for your renewal!

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

info@mountbeauty.org.au

Open 10am - 3pm

Monday to Friday (excluding Public Holidays)

Mount Beauty Neighbourhood Centre Inc.

Acknowledges the support of the Victorian Government.

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