Cekor MDC Membership Application Form

Membership Application Form

ABN: 40 642 127 893 | ACN: 642 127 893 | info@cekor.com.au
All information provided on this form will be held in confidence and will only be used for membership purposes.
Membership Type
Personal Details
Name:

First NameLast Name
Date of Birth:

DayMonthYear
Date
Address:

Street Address

SuburbState / Province

Postal / Zip Code
Mobile Number:
Email

Not for Profit Public Company Limited by Guarantee

ABN: 40 642 127 893 | ACN: 642 127 893| info@cekor.com.au
Terms and Conditions:

I {name56},
- have read the rules and regulations and agree to comply with all the terms and conditions outlined in the document.
- agree as a member of Čekor Macedonian Dance Company Ltd to contribute an amount no more than $100 (the gurantee) to the property of the company if it is to wound.
- hereby consent and agree that Čekor Macedonian Dance Company Ltd may use my name or photographs/videos for marketing or advertising purposes in any media form. I waive any rights, claims or interests I may have to control the use of my identity or likeness in the photographs/videos and agree that any uses described herein may be made without compensation or additional consideration.
- declare that the information provided on this form is complete and correct.
Signature
Payment Type:
NOTE: A 2.3% surcharge is added to online payments
Calculation

Membership Application Form