Individual Membership Application Complete this form and click “submit” below, or post a hard copy to North West FM, 100 Middle Street, Hadfield 3046. Please enable JavaScript in your browser to complete this form.Name: *FirstLastResidential Address (house number, street name, suburb): *Postcode: *Email: *Phone: *Are you over 18 years of age? *YesNo - parental permission must be obtained and this form must be signed by your parentWhat type of membership would you like to apply for? *Individual - $30Individual and Partner - $40Family (includes children under 18 years of age) - $46Concession - $18Listener Sponsor - $18How would you like to assist North West FM?Listener / SupporterFund RaisingLibraryProductionProgramPromotionsIf there is anything you would like to let us know about your application, please write it belowMembership Agreement *--- Select Choice ---I AGREEIn submitting this electronic application for membership to North West Community Radio Association Inc - I hereby agree to adhere to the rules for membership application as set out in the Rules of Association and further: (a) wish to become a member of the Association; and (b) support the purposes of the Association; and (c) agree to comply with the rules of Association. All membership applications must be approved by the committee of management prior to the commencement of membership. 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: 00906727EmailSubmit
