Clone of PICQ Membership Application

Membership Renewal Form
This form is for current PICQ members wishing to renew their membership.

To maintain a valid membership with PICQ, you must:
- Pay the applicable membership fee
- Complete and submit this renewal form.
Please note: Membership payments received without a completed renewal form cannot be processed as a valid membership renewal.

Need help? Contact us at secretary@picq.com.au and we will be happy to assist.
Which type of membership would you like to renew?
Name of Organisation
Does your group have an ABN?
ABN
Include Organisation's Office Members and Names
President : 
Vice President: 
Secretary : 
Treasurer: 
If any positions do not apply, indicate with NA
Contact Person
Pacific Island organisation is affiliated with
Organisation Email
Organisation Address
Personal Details for Individual and Associate Membership

Associate memberships are subject to annual committee approval due to the limited number of positions available.
I understand that as an Associate Member I do not have voting rights
Title
DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Full Name

First NameLast Name
E-mail
example@example.com
Phone
Pacific Island Country of Affiliation
Address
City
State
Tell us how you would like to contribute to PICQ
Include skills or experience you bring, or voluntary support you can offer
Declaration
I hereby declare that all information provided in this form is true, correct and complete. I understand that providing false or misleading information may result in cancellation of membership.
Signature
Membership Renewal and Receipt
To complete your renewal, please upload a copy of your payment receipt below. This can be a screenshot, photo, or scanned copy of your receipt or online transaction. For cash payments, please pay directly to your nearest Suncorp branch and simply take a photo of your deposit receipt and upload it here.

Please use your name as reference when making online payments.
BSB: 484799 | Acct No. 602063280

Account Name: PICQ Suncorp
Upload Receipt

Cancelof
Should be Empty:

Membership Renewal Form

Personal Details for Individual and Associate Membership

Declaration

BSB: 484799 | Acct No. 602063280