Canberra Railway Museum new member application form

Canberra Railway Museum

MEMBERSHIP APPLICATION FORM
canberrarail.org.au

2 Geijera Place, Kingston ACT 2604

Mail to PO Box 445, Fyshwick ACT 2609
Please fill out a new form for each individual applicant.

I hereby apply to become a member of:
- Capital Region Heritage Rail Limited (ABN 99 625 904 663) and
- ACT Heritage Rail Holdings Limited (ABN 91 625 924 627)
And agree to:
- Support the objectives of the companies and
- Be bound by the Constitution and By-laws of the companies and
- Abide by the Code of Conduct of the Museum.
Title

MrMrsPrefer not to answerOther
Name*

First NameLast Name
Preferred Name
Street address*
Town/City*
State*
Postcode*
Country*

AustraliaOther (please specify)
Contact phone (Landline)
Contact phone (Mobile)
Email address for notices and newsletters
Distribution of Notices and Newsletters by email is preferred. If you require them posted to you and have paid the $15.00 postage surcharge (see below) please tick this box:

I require distribution of notices and newsletters by post
Skills & experience
Canberra Railway Museum relies on and values the volunteer efforts of its membership. If you have skills and experience you believe would be beneficial to the museum, please use the space below to give details on your experience, qualifications, etc.
(If Retired, please show pre-retirement occupation and qualifications)
Signature of Applicant*

Clear
Date*

MonthDayYear
The Canberra Railway Museum respects the privacy of the individuals it deals with and complies with the Privacy Act 1988. Consistent with this, we with not disclose our members personal information to third parties except to facilitate the provision of services to those members or as otherwise required by law but may provide such information to our operational people to facilitate the management and operations of the Museum, or to other agencies as required for accreditation, insurance. or other relevant requirements. Members may arrange to access their personal information by contacting the Secretary.
Membership groups and rates for renewing members

(GST included where applicable)
Membership year: to 30 June annually
Membership class (select one)*

Ordinary member - Adult (voting) $55.00Ordinary Member - Concessional (voting) $27.50Ordinary Member - Junior (non-voting) $22.00Corporate Member (non-voting) $55.00
Concessional rate only applies to holders of Pensioner Concession Cards

Junior rate only applies to persons under 18 years of age

Corporate rate only applies to incorporated entity
If applying as concessional member, please record concession card number:
If applying as junior member, please record date of birth:

MonthDayYear
Date
Donations and surcharges
Donation to Capital Region Heritage Rail Ltd. for the maintenance and development of the Canberra Railway Museum
Donation to ACT Heritage Rail Holdings Ltd. gift fund to be used for the preservation and restoration of rolling stock and museum assets
$15.00 surcharge for distribution of newsletters by Australia Post
TOTAL AMOUNT TO BE PAID*
I am paying by:

Cash - in person at museum workdays / meetings (Do not send cash by mail)Cheque / Money order made out to Capital Region Heritage Rail LimitedDirect deposit to Capital Region Heritage Rail Limited (See below)
Westpac Bank

Account No.: 272895

BSB: 032-747

Payment description: CRMApply (Family Surname)
If you encounter any issues while completing this application, please reach out to secretary@canberrarail.org.au

If you have any questions or issues regarding your museum membership, please reach out to membership@canberrarail.org.au

Approved by: CRHR Board

Owned by: Membership

Issue date: May 2023

Review date: May 2024
Should be Empty:

Canberra Railway Museum

Skills & experience

Membership groups and rates for renewing members

Donations and surcharges