PICQ Membership Application

PACIFIC ISLANDS COUNCIL QLD | MEMBERSHIP FORM
Mission: Represent the voice and views of Qld based Pacific Island national organizations.
The Pacific Islands Council Qld is a non-profit community incorporated association managed by volunteer representatives of member community groups and individuals who believe in the collective voice for the benefit of all Pacific Islanders

We invite you to complete and submit the membership application form to begin your journey with us. The outcome of your application will be shared with you via email.

If you have any problems completing the form please don't hesitate to contact us at info@picq.com.au
Which type of membership would you like to apply for?*

Individual Annual Membership -$20Association or Group Annual Membership- $100Association or Group Annual Membership + Public Liability Insurance -$300
If applying for a Association or Group Membership
Name of Association or Group
Name of Proposer*
Email of Proposer*
example@example.com
Name of Seconder*
Email of Seconder*
example@example.com
Title*
DOB*

MonthDayYear
Full Name*

First NameLast Name
Address
City
State
Area Code
Pacific Island Country of Affiliation*
Phone*
E-mail*
example@example.com
Occupation*
PICQ has various Networks. Which of the following would be areas of interest?

Climate ChangeJusticePICQ YouthPacific Women's AlliancePacific Church Leaders Network
Your membership fee will become payable once your application has been approved. Payment details, including bank account information, will be provided at that time.
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