Millthorpe Village Committee Membership Form

Community Committee Membership Form

Please fill out your details to join as a village or business member.
Select Membership Type*

Village Member ($10/year)Business Member ($85/year, includes one village membership)
Village Member Details
Full Name

First NameLast Name
Email Address
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Sub Committee Interests

Youth ClubGarden ClubRamble Member
Business Member Details
Business Name
Contact Name

First NameLast Name
Contact Email
example@example.com
Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Opening Days and Hours
Business Description
Business Website Link
Facebook Link
Instagram Link
Main Business Photo (Horizontal)

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Square Business Photo 1

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Square Business Photo 2

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Square Business Photo 3

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Square Business Photo 4

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Membership Payment
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Village Member
Annual membership for individual village residents.

$10.00AUD

Business Member
Annual business membership (includes one village membership).

$85.00AUD

Total

$0.00AUD
Payment Details

Payment to be made via direct deposit. Once received you will receive a receipt.
Name: Millthorpe Village Committee Inc.
BSB: 062 587
ACC: 00931101
Reference: Your name/business name
Should be Empty:

Community Committee Membership Form