TELEPHONE NUMBER: FAX NUMBER: E-MAIL ADDRESS: MEMBERSHIP FEES: (inclusive of GST) (please tick appropriate) Organisations Blacktown/The Hills $30.00 – Government & Local Councils $40.00 Non-Government Organisations Outside of the LGA $35.00 Individual $15.00 Student/Concession $5.00 Current membership expires(ed) on 30th June 2017. Please Note: □ □ Does your organisation have: PBI and/or DGR status? (please tick) Forward a copy of this form to CRN with your payment, or tick if paying by direct bank transfer Email: Fax: (02) 9832 4802 Post: P.O. Box 149, Plumpton NSW 2761 □ Paying by direct bank transfer Date transferred: ...................................... Bank Details: Commonwealth Bank BSB: 062 317 A/C No: 10410707 Please list your organisation, or name (if individual membership) as the Payee.
TELEPHONE NUMBER: FAX NUMBER: E-MAIL ADDRESS: MEMBERSHIP FEES: (inclusive of GST) (please tick appropriate) Organisations – Blacktown/The Hills $30.00 Government & Local Councils $40.00 Non-Government Organisations Outside of the LGA $35.00 Individual $15.00 Student/Concession $5.00 Please Note: Current membership expires(ed) on 30th June 2017. Does your organisation have: PBI □ and/or DGR □ status? (please tick) Forward a copy of this form to CRN with your payment, or tick if paying by direct bank transfer Email: Fax: (02) 9832 4802 Post: P.O. Box 149, Plumpton NSW 2761 □ Paying by direct bank transfer Date transferred: ...................................... Bank Details: Commonwealth Bank BSB: 062 317 A/C No: 10410707 Please list your organisation, or name (if individual membership) as the Payee.
CRN-Membership-Application-Form-2017-2018.docx