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  • APPLICATION FOR MEMBERSHIP

  • SECTION 1: APPLICANT DETAILS

  • DATE OF BIRTH (DD/MM/YYYY)
     - -
  • Format: (000) 000-0000.

  • You may choose to register children under 18 years of age to your membership.
    If registering children, you must provide a birth certificate and complete the details below.

  • DATE OF BIRTH (DD/MM/YYYY)
     - -
  • DATE OF BIRTH (DD/MM/YYYY)
     - -
  • DATE OF BIRTH (DD/MM/YYYY)
     - -
  • DATE OF BIRTH (DD/MM/YYYY)
     - -

  • I consent to Yamatji Southern Regional Corporation keeping my children's birth certificates/identification on file.

  • DATE:
     - -

  • MY APICAL ANCESTORS

  • PLEASE TICK YOUR APICAL ANCESTOR/S, YOU CAN PICK MORE THAN ONE.*
  • For guidance, please refer to Appendix A at the back of this form for an overview of Apical Ancestor locations.

  • CULTURAL CONNECTIONS

  • My cultural group connection/s within the Yamatji Nation ILUA Agreement area is (Please Tick): Please select the cultural group you are connected to:*
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  • Indigenous Land Use Agreement (ILUA) Map Cultural Committee Groups

  • PAGE 2

  • SECTION 3: FAMILY DETAILS AND CONNECTIONS

  • Your family details are important. They help YSRC connect you to other family members, the ILUA area, and your apical ancestors. Please complete as many details as you can. Start with your parents, then grandparents (Nan/Pop), followed by great grandparents and earlier generations if known.
  • DATE OF BIRTH*
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  • DATE OF BIRTH*
     - -
    • Mum's Side 
    • DATE OF BIRTH:
       - -
    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
       - -
    • DATE OF BIRTH:
       - -
    • Dad's Side 
    • DATE OF BIRTH:
       - -
    • DATE OF BIRTH:
       - -
    • DATE OF BIRTH:
       - -
    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • DATE OF BIRTH:
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    • PAGE 3
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  • DATE:*
     - -

  • OFFICE USE ONLY

  • DATE APPROVED:
     - -

  • CONTACT DETAILS:

  • Phone: 08 9934 6890
    Email: members@ysrc.com.au
    Address: 7 Wiebbe Hayes Lane, Geraldton
    Postal Address: PO Box 552, GERALDTON WA 6531

  • PAGE 4
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  • APPENDIX A

  • Indigenous Land Use Agreement (ILUA) Map
    Apical Ancestors & Cultural Committee Groups

  • LEGEND
    Hutt River
    Mullewa Wadjari
    Southern Yamatji
    Widi Mob
    Towns

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  • Ancestor locations are approximate and provided for guidance only.

  • APPENDIX B

  • 8. MEMBERSHIP

  • 8.1 ELIGIBILITY

  • The Company shall have Ordinary Members and Associate Members.
    Ordinary Membership of the Company is open to any person who is:
    i) an individual who is at least 18 years of age;
    (ii) a Yamatji Nation Person; and
    (iii) not the subject of having been expelled as a Member within the immediately preceding 5 years.


    Associate Membership of the Company is open to any person who is:
    (i) a spouse or parent of a Yamatji Nation Person;
    (ii) between 16 and 18 years of age and who would otherwise be eligible to be a
    Member once over 18 years;
    (iii) a guardian or caregiver of any of the above, or
    (iv) any other person, determined by Special Resolution at a General Meeting.

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  • PHONE
     (08) 9934 6890


    EMAIL
    members@ysrc.com.au


    POSTAL ADDRESS
    PO Box 552, Geraldton WA 6530

  • HEAD OFFICE GERALDTON
    7 Wiebbe Hayes Lane, Geraldton WA 6530

  • PERTH OFFICE
    101 Edward Street, Perth WA 6000

  • WEBSITE

    www.ysrc.com.au

  • ACKNOWLEDGEMENT OF COUNTRY

  • Yamatji Southern Regional Corporation acknowledges the Traditional Owners
    of Country throughout Australia and recognises their continuing connection to land,
    waters and community.

  • We pay our respects to them and their cultures;
    and to elders both past and present.

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