Application for Membership

Membership Fee : $10.00 Concession Card Holder : $5.00

Only financial Members of the Forum are eligible to vote at Meetings.

Name : ……………………………………………………….…..

Title : ……………….…….….

Representing the following Organisation (if applicable) –

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Contact Phones : ……………………………… (BH)

…….…………….…….....................…………… (AH)

Contact E-mail : ……………………...………….......

Contact Address : ……………………………….......

I, the undersigned, hereby confirm that upon being accepted as a Member I will abide by the Rules and Constitution of the GEELONG COMMUNITY FORUM INC.

Signed : ……………………………..….

Date : …………………………………

PAYMENT ENCLOSED : CASH / CHQ

Membership Fee $..............
Donation               $..............
Total Payment      $..............

Print this page and send to

GEELONG COMMUNITY FORUM INC.
P O Box 2016, Geelong, Victoria 3220