MEMBERSHIP RENEWAL
6SEN Capital Community Radio 101.7 FM & Digital
First Name
*
Last Name
*
Email
*
example@example.com
Membership No.
Optional - don't worry if you can't remember it.
Mobile
Example: 0481 123 456
Optional further details
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Address
(If different from that previously provided)
Street Address Line 2
Suburb / Town / City
State & Postcode
Postal / Zip Code
Suburb or Town or City
Postcode
Example: 6100
Mobile No.
Example: 0481 123 456
Landline No.
Example: 08 9123 4567
Optional: Would you like to add a donation?
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Yes
No
Please select 'Yes' if you would like to add a donation. Select 'No' to cancel an entry. A Tax-Deduction receipt will be emailed immediately.
Donation amount
Please help support Capital Community Radio's operating costs
Membership Types and Annual Fees:
*
Single $36
Couple $56
Single Seniors Card holder $32
Couple Seniors Card holders $50
Membership Type
Subscription
MemFee&Donation
Total amount to be charged
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AUD
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