Organisation Membership Application Form

Complete this form and click “submit” below, or post a hard copy to North West FM, 100 Middle Street, Hadfield 3046.

Name of Organisation: *

Contact Name: *

Position in the Organisation: *

Address of Organisation *

Email *

Phone: *

If there is anything you would like to let us know about your application, please write it below

I confirm that in applying to become a member of North-West Community Radio Inc (Association), the Organisation I am applying on behalf of wishes to become a member of the Association, supports the purposes of the Association and agrees to comply with the Rules of the Association: *

By typing my name below, I confirm that I am authorised to sign this form by the Organisation that the Membership Application relates to and that I am signing this Membership Application Form on behalf of that Organisation as provided for and in accordance with section 9 of the Electronic Transactions (Victoria) Act 2000 (Vic) *

Website

Payment of the relevant membership fee may be made to the following bank account (please use your surname as the payment reference):

Commonwealth Bank

North West Community Radio Assoc. Inc.

BSB: 063-135

ACC: 00906727