Membership Application Capital Community Radio

MEMBERSHIP APPLICATION

6SEN Capital Community Radio 101.7 FM & Digital
First Name*
Last Name*
Email*
example@example.com
Date

DayMonthYear
Date
Address*

Street Address Line 2

Suburb / Town / CityState & Postcode

Postal / Zip Code
Suburb, Town or City*
Postcode*
Example: 6100
Mobile No.*
Example: 0481 123 456
Landline No.
Example: 08 9123 4567
Membership Types and Annual Fees:*

Single $36Couple $56Single Seniors Card holder $32Couple Seniors Card holders $50
Optional: Would you like to add a donation?
Please select 'Yes' if you would like to add a donation. Select 'No' to cancel an entry. A Tax-Deduction receipt will be emailed immediately.
Upon approval of your application for membership (in accordance with the Constitution), you will be a Member and receive a Membership Card by post. Please note that a Member is only liable for their outstanding fees payable under rules 9.1 and 9.2 of the Constitution. No Member is liable by reason of their Membership for the liabilities of Capital Community Radio or the costs of winding it up.
Would you like to be a volunteer?
Applicant's declaration*
Donation
Please help support Capital Community Radio's operating costs
Membership Type
Subscription
MemFee&Donation
Transaction type
Paid By
Total amount to be charged

prevnext( X )
AUDDescription

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

MEMBERSHIP APPLICATION