Wootton Community Network - Membership Renewal Form

Membership Renewal

(CONFIDENTIAL – one form per member)
Name*

First NameLast Name
Wootton Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Postal Address (if different from local address)

Street Address

Street Address Line 2

SuburbState

PostcodeCountry
Phone*

Area CodePhone Number
E-mail*
Website (if applicable)
This is my/our:*

FarmHomeBusinessWeekenderOther
ANNUAL MEMBERSHIP FEE: $20
Payable by direct deposit to:

Wootton Community Network Inc.

Regional Australia Bank

BSB: 932000

Account: 500023558

Reference: “WCN22” and your name

Please email when paid to notify the Treasurer woottonguesthouse@gmail.com

Alternatively, you can post a cheque to The Secretary, Wootton Community Network, 1633 Wootton Way, Wootton NSW 2423.
I agree that my contact details will be supplied to other members for networking purposes.*

YesNo
Your Signature*

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