Nirmalya Membership Registration Form

NIRMALYA MEMBERSHIP APPLICATION

Complete the form below to raise a request for our membership service.
Name*

First NameMiddle NameLast Name
E-mail*
Phone Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Where did you hear about us?

A Friend or colleaugeGoogleBlog PostNews ArticleOther
Membership Type*

Individual (AUD 20)Family (AUD 50)
Account Details:

Account Name: NIRMALYA INCORPORATED

BSB: 062711

Account number: 10030571

PayID Details:

PayID Type: ABN

PayID: 42760631934

Beem_it:

@nirmalya
Upload an Image confirming the payment to above account.
Number of Adults
Number of Children
Preferred way to contact*

PhoneEmailAny
Membership Rules
1. Membership is available to anyone 18 years of age or older and their individual family members.

2. You consent that you have gone through the association constitution (Click here to access the constitution) and agree to be abide by the rules of the association as defined in that or is formulated in due course.

3. Your membership request will be reviewed and if found suitable will be accepted by the managing committee.

4. Membership will be active after a decision is made to accept the request and membership fee is credited to the association account.
I have read, understood, and accepted the rules for membership.
Privacy Policy
Please read our Privacy Policy to understand how your information is used and shared, and check below if you accept the policy. You agree and provide consent to Nirmalya reaching out to you using your provided contact details. Your details will be maintained in the membership register as required by the regulation.
I have read, understood, and accepted the PRIVACY POLICY for membership.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Membership From

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Date
Member to

DayMonthYear
Date
Status
Should be Empty:

NIRMALYA MEMBERSHIP APPLICATION

Membership Rules

Privacy Policy