Membership Application

Membership Application
Name

First NameLast Name
Postal Address

Address Line 1

Address Line 2

CityState

Postcode
Home Phone Number
Please enter a valid phone number.Format: (00) 0000 0000.
Mobile Phone Number
Please enter a valid phone number.Format: 0000 000 000.
Email
example@example.com
Nominators

If you are unable to complete the first and/or second nominator details below, leave blank
First Nominator
First Nominator Contact Details
Second Nominator
Second Nominator Contact Details
If accepted as a Member of Port Stephens FM Radio Incorporated, I agree to abide by its Constitution, Policies and Procedures and related guidelines.
Signature
Membership Fee
Donation
Port Stephens FM is a community based not for profit organisation. Any additional support you can provide would be greatly appreciated.
Total
Payment Method
EFT Payment Details:

Greater Building Society, Salamander Bay

BSB: 637 000 Account Number: 781 743 666

When paying by EFT, put your name as a reference on the transaction.

AUDDescription