LVIA Membership Application

LVIA Membership Application

To apply for membership please complete all questions.
Name*

PrefixFirst Name/sLast Name
Mobile Number*
Please enter a valid mobile phone number.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Membership Annual*
prevnext( X )
1 Year MembershipAnnual Membership essential for AGM nomination and voting
$10.00AUD

Total

$0.00AUD
LOCKYER VALLEY ISLAMIC ASSOCIATION Inc
Bank: WESTPAC
BSB: 034182
Account No: 275667

Reference: Membership First & Last Name
Click on the Square App Link here and select once off payment. Amount $10.
Submission Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
By submitting this form I confirm my application for membership to the Lockyer Valley Islamic Association Inc.| Gatton Musjid.

Only signed up and paid up members can be nominated onto the committee and have voting rights at the Annual General Meetings.

LVIA Inc manages the day to day activities of the Gatton Musjid, and you are encouraged to become a member of the Association.
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