Application for Membership
To become a member, your application must be nominated and seconded by a current member of NQWLS. Once your application has been submitted it will be provided to the Management Committee for verification/approval.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Areas of Interest
*
Do you have any skills, experience (including life experience) and/or knowledge that you can contribute to NQWLS
*
I enclose payment (or confirmation if via direct deposit) of my annual subscription fee:
*
$10.00 inclusive of GST where employed and able. Payment can be made to: North Queensland Women's Legal Service - BSB: 064 817 - Account: 10885093
Separate donation amount. Donations over $2 are tax deductible. If choosing this option, please specify below payment amount. Payment can be made to: North Queensland Women's Legal Service - BSB: 064 817 - Account: 10885093
Other Amount:
Signature
*
Date
*
-
Day
-
Month
Year
Date
Submit
Submit
Continue
Continue
Should be Empty: