CCBARC Membership Application Form

CCBARC[1] logo med.jpg

CCBARC Incorporated
(Central Coast Beach Access Reform Coalition)

Address: CCBARC C/- PO Box 5285 Erina Fair NSW 2250

                                    Email: ccbarc@gmail.com                             Tel: 4382-4525 

President: Dr Brad McPartland BVSc (Hons)                                         Treasurer: Dr Andrew Radcliffe BVSc

    Sec/Public Officer: Rosalind Bonser LLB, Grad Cert.Bus.                  Finance Chair: Charmaine Bright

Application for 12 months membership of CCBARC Incorporated  
(Incorporated under the Associations Incorporations Act 1984).
Date___________     

I/We___________________________________________________________________________________________
                                (Full Names of applicant/s)

Of _____________________________________________________________________________________________
                                (Address)                                                                                            (State)              (Postcode)

Hereby apply to become a member of CCBARC incorporated association. In the event of my admission as a member, I agree to be bound by the rules of the association for the time being in force.

________________________________________________________________________________________________________
(Signature of  Applicants )


# Of Pets_______           Dog/s_________     Cat/s_________ Other________________________________

 

Please include your Email Address  if you wish to be receive updates and information from CCBARC

Email ___________________________________________________________________________________

Phone __________________________       Mobile_____________________________________________

Payment Options  - Please mail this form and cheque to the above address or
Pay In person at Gosford Grooming Salon 2 Deane St Narara

Direct Deposit  to Account Name - CCBARC Inc  BSB 082-574 Acc. No. 5266 51991
National Australia Bank, Erina. Reference   - Please include your Surname & forward bank deposit receipt to the above email address.

$____________$20.00 Individual,  $25.00 Family  $12.00 Pensioner $40.00 Business
$____________ Donation
$____________ $ 10.00 Cap/ Other
$____________ Total

 

I____________________________________ a member for the association, nominate the Applicant, who is personally known to me, for

 membership of the association.______________________________________      ______________
                                                                                                (Signature of proposer)                (Date)                     

I_____________________________________ a member for the association, second the nomination of the Applicant, who is personally

 known to me, for membership of the association __________________________________         __________
                                                                                                                                Signature of seconder)            (Date)