DOUGLAS
SHIRE
SUSTAINABILITY
GROUP
PO Box 762, Mossman. 4873
NAME:.........................................................................................................
ADDRESS:...................................................................................................
...................................................................................................
PHONE:........................................................................................................
EMAIL:.........................................................................................................
OCCUPATION:.............................................................................................
DATE OF
APPLICATION:........................................................................
SIGNED:......................................................................................................
Other than your valued membership, can you offer support in other areas?
LEGAL ISSUES
__ ACCOUNTING __
POLITICS
ENVIRONMENT __
MEDIA __
FUNDRAISING
DETAILS:..............................................................................................................................................................................................................................................................................................................................................................................................................................
DO YOU WISH TO BE INCLUDED IN THE EMAIL DATABASE
YES/NO
PLEASE NOTE MEMBERS MUST BE
FINANCIAL TO VOTE.
Family
Membership $20 (one membership = one vote)
Bendigo Bank BSB 633108 Account No 128168754
NOMINATED
BY:.............................................. Signed........................................
SECONDED BY:.................................................
Signed........................................
RECEIPT NO:......................................
MEMBERSHIP NO:..................................
Members
must accept and abide by the objects of DSSG as set out in the constitution.