Membership Application Form for Association

Clarence Childhood Services Association Incorporated

A community-based organisation for children and families, not for profit

162 Turf St, GRAFTON 2460 Phone: 02 6643 1002 Email: info@ccsainc.com.au
Membership Application Form
Name*

First NameLast Name
Date of Birth

DayMonthYear
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal Address (if different)
Contact Phone No*
Contact Email*
example@example.com
Your Rights/Privacy:
I understand that under the terms of CCSA Inc. Constitution, the *Register of Members must be open for inspection (if requested), free of charge, to any member of the association.

I also understand a member can request that only the member's name be made available for such inspection.
Accordingly, I hereby elect my information on the *Register of Members be treated as follows (please tick 1 box below)

(a) Only my name should be made available if the register is requested to be opened.(b) I give permission for my details contained on the register to be open for inspection.
Terms and Conditions:
1. I, the undersigned, hereby apply for membership of the Clarence Childhood Services Association Incorporated.
2. In the event of my admission as a member, I agree to be bound by the Constitution of the Association for the time being in force.
3. If my membership is approved I agree to pay the joining fee of $5.50 within 28 days of receiving advice of my acceptance by the Committee whereupon I will be entered into the association's *Register of Members.
4. I understand that membership fees are:-
  1. required to be paid annually within 3 months of the new financial year
  2. non-refundable (even if a membership is varied, suspended or cancelled)
  3. that my membership is not transferable.
Signature of applicant

Clear
Date

DayMonthYear
Date
Should be Empty:

Clarence Childhood Services Association Incorporated

Membership Application Form

Your Rights/Privacy:

Terms and Conditions: