FRIENDS NETWORK AFFILIATION DETAILS

NAME OF GROUP ..............................................................................................................................................................

MELWAY REFERENCE (or location) ......................................................................................................................

NAME OF CONTACT PERSON .............................................................................................

Address ...............................................................................................................................

............................................................................... Postcode ..........................

Phone (H) ................................................ (B) .......................................... Mobile ........................................................

Fax ................................................. E-mail ..........................................................................................

NETWORK NEWSLETTERS TO BE FORWARDED BY: Mail / E-mail (circle one)

IF GROUP HAS WEB PAGE, GIVE WEB ADDRESS ....................................................................................................

IS GROUP INCORPORATED? yes / no NUMBER OF MEMBERS ..............................

MANAGEMENT AUTHORITY ............................................................ MUNICIPALITY ...................................................

DOES THE GROUP MEET THE CRITERIA FOR AFFILIATION WITH THE NETWORK? yes / no

PLEASE STATE (OR ATTACH) THE OBJECTIVES OF THE GROUP

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WHEN WAS THE GROUP FORMED? ..........................................................

DOES THE GROUP PRODUCE A NEWSLETTER? yes / no

If yes, at what frequency? ......................................................................

DOES THE GROUP HOLD PROJECT DAYS ON A FIXED DAY(S)? yes / no

If yes, when?.........................................................................................................................

Signed .......................................................................................................... Date ..................................................