Membership Application Form

Ratepayers Victoria, Inc. (A0040924M)

Membership Application/Renewal: 1/7/2017 to 30/6/2018

Name_____________________________________________________________________

Name (of organization if relevant)______________________________________

Shire/Council___________________________________________________________

Address _________________________________ _____________________________

_______________________________________________________________________

Phone_________________________ Mobile _______________________

E-Mail_________________________________________________

In the event of my admission to membership, I agree to be bound by the rules of the Association
for the time being in force, to pay annual membership dues as determined by the association,
and to work cooperatively with the other members.

Signature: ________________________ Date______________

Enclosed: $ _______________________

Membership Fees: $10 Pensioners: $20 Individuals: $40 Organization

Additional donation optional $_____________________

Cheque/Money Order /Cash or
Bank deposit to : Ratepayers Victoria Inc.
BSB: 063855 Account No: 10127765
Whittlesea branch
________________________________________________________
Mail To:
The Secretary
Ratepayers Vic Inc.
8/1248 North Road; Oakleigh South 3167
Email: RatepayersVic@outlook.com Phone : 03 9570 6227

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