Application for Membership

Application for Membership

Please complete and submit the form below. A tax invoice for the membership fee will then be issued. For all enquiries please call Secretary Sam Byrne on 02 9057 5155, 0408 231 509 or email him at sec@ fed.coop.
Name of Applicant*
(Legal name of Co-operative/Body Corporate)
Postal Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Street Address*

Street Address (The co-operatives actual location)

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number (Work)*
Please enter a valid phone number.
Email Address*
(We will send annual membership invoices to this address unless another contact is specified below)
I would like membership invoices to be sent to a different email address (optional)
Finance email address
Has the applicant co-operative/body corporate been in existence for less than twelve (12) months?*
If more than twelve (12) months, what was your turnover less government grant funds for the last financial year?*
Nominated Representative of Applicant:
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Representative Email*
Relationship to Applicant*
(Member/Director/CEO/Secretary/Other - Please Specify)
I am authorised to act on behalf of the applicant named above and I:*

Apply for it to be admitted as a member of The Co-operative Federation LtdAppoint the above-named person to represent it in relation to its membershipConsent to the use of the above email address for the services of notices from the Federation.
If this application is approved, the applicant agrees:*

It will pay all fees required by the FederationIt will be bound by the Rules of the FederationThat the contact details of the applicant may be circulated to all other members of the Federation to assist with networking amongst co-operatives.
Signature

Powered by Jotform SignClear
Should be Empty: