membership form

Ratepayers Victoria, Inc. (A0040924M)
Membership Application/Renewal: 1/7/2017 to 30/6/2018

Name _______________________________________________________________________

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______________

Membership Fees: $10 Pensioners $20 Individuals $40 Organization
Enclosed: $
Additional donation optional $____________________
Cheque/Money Order /Cash or
Bank deposit to: Ratepayers Victoria Inc.
BSB No: 063 855 Account No: 10127765
Whittlesea branch________________________________________Mail To:
The secretary
Ratepayers Victoria
8/1248 North Road Oakleigh South 3167

RatepayersVic@outlook.com

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