APPLICATION FOR MEMBERSHIP OR MEMBERSHIP RENEWAL
Membership is open to Villages as a whole OR to individual residents:
Villages: $2 – per OCCUPIED residence per year.
Individual: $10 – per person per year.
Payments: due from the 1st January each year.
DETAILS FOR VILLAGE OR INDIVIDUAL MEMBERSHIP
NAME (INDIVIDUAL)............................................................................................
ADDRESS…………………………………………………………………………
…………………………………................…PHONE………………….................
VILLAGE MEMBERSHIP
NUMBEROF OCCUPIED RESIDENCES IN VILLAGE @ 1STJANUARY……
RESIDENT FOR CONTACT IN VILLAGE………………………………..........
CONTACT TELEPHONE NUMBER...................................................................
CONTACT E-MAIL ADDRESS…………………………………………………..
RESIDENT COMMITTEE SECRETARY............................................................
E-MAIL................................................................PHONE................................
DATE OF APPLICATION………………………………………..........................
SIGNATURE OF APPLICANT……………………………………………………
Please forward, together with payment to:
The Treasurer, Ron Hasluck
23/41 Geograph Way
Thornlie WA 6108
Inquiries: Telephone: 9456 1991
Receipt No.................................. Revised January 2011