5547840 - Clone of YBSS Membership Form 2023

If you would like to become a financial member of Yumba Bimbi Support Services complete the details below:

Our commitment to privacy – Yumba Bimbi Support Services is committed to comply with the Privacy Act 1988 (Cth) and other laws which specify how organisations may gather and use personal information. A description of the way in which we collect, hold, use and disclose personal information is set out in our full Privacy Policy, which complies with the Australian Privacy Principles (APPs). Our full Privacy Policy is available at www.yumbabimbi.com.au.
Name

First NameLast Name
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Email
example@example.com
Are you over the age of 18? (Required by our consitution.)

YesNo
My connection with Yumba Bimbi Support Services is:

I am a person with a disabilityI have a family member with a disabilityI volunteer for Yumba Bimbi Support ServicesI donate/fundraise for Yumba Bimbi Support ServicesMy place of employment works in partnership with Yumba Bimbi Support ServicesI am a community member with an interest in the work of Yumba Bimbi Support Services
Membership terms and conditions: I agree to receive annual membership renewals. I understand that I may cancel my membership at any time by providing two weeks' written notice to Yumba Bimbi Support Services and that the membership fee is non-refundable.

I agree
Payment method

Pay in cash (or EFTPOS)Direct DepositPayPal/Credit Card
You can pay pay in cash or EFPOS at our main office 56 Anakie Street, Emerald. Call 07 4987 7933 to pay over the phone.

Direct Deposit Details:

Yumba Bimbi Support Services

BSB: 084-646

Account Number: 437596273

Please reference YBM(yourname)
Should be Empty:

If you would like to become a financial member of Yumba Bimbi Support Services complete the details below: