ANMC Membership Form

ANMC Membership Form

Please complete your details below to apply for the membership of Australian Nepalese Multicultural Centre. Upon submission of this form, payment details will be forwarded to your email or please visit membership stand for payment.
1. Membership Type (Please choose one of the followings):
Membership Fees:
General Member: Single $100, Family $200 |
Life Member: Single $1000, Family $1500.
Life Membership can be paid by insallment or upfront.
Membership *

General MembershipLife Membership
Membership Type*

SingleFamily
2. Applicant's Personal Details
Full Name*

First NameLast Name
Residential Address*

Street Address 1 :

Street Address 2:

Suburb:State:

Postcode:
Postal Address (leave blank if same as above)

Street Address:

Street Address:

Suburb:State:

Postcode:
E-mail*
Mobile*
Gender*

MaleFemale
Your Age
Your current age in years eg 30. For statistical purpose only
3 Family Members included (Include all family members/ leave blank if applying for individual membership)
Spouse/ Partner's Name

First NameLast Name
Relationship
Age
Your current age in years eg 30. For statistical purpose only
Family Member 1

First NameLast Name
Relationship
Age
Dependent child must be under 18 to be included in family membership
Family Member 2

First NameLast Name
Relationship
Age
Dependent child must be under 18 to be included in family membership
Family Member 3

First NameLast Name
Relationship
Age
Dependent child must be under 18 to be included in family membership
Comments
4 Payment Option

Please select one of the payment options. Payment can be made by bank transfer or at the membership stand by EFTPOS
Payment Type

Upfront PaymentInstallments
4 Declaration*

By ticking this box and submitting this application, I declare that:
1. I state that the information I have provided is true and correct to the best of my knowledge. I will notify ANMC of any changes to the address and contact information.
2. I agree to be bound by the constitution of the ANMC and by all valid resolutions passed by the ANMC.
3. By submitting this form, I agree to receive communications from ANMC in form of email or other format.
4. I understand that checking in the signature box in electronic form is equivalent of physically signing form.
DECLARATION*

Yes I accept above declaration
Enter the word as it's shown*
Payment Received?
For ANMC Use only
Certificate Name
Date

MonthDayYear
Date
Should be Empty: