Application for Membership or Renewal by lindayy

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									DEEPWATER AND DISTRICTS COMMUNITY F.M. RADIO INC

91.1 Deepwater 105.9 Glen Innes
P.O. Box 129
GLEN INNES 2370
Phone: 6732 1270       Fax: 6732 1490

Web: WWW.2cbdonline.com


Application for Membership or Renewal
Surname: _________________________ Christian Names: _________________________
Address:____________________________________________________Postcode_______
Home Phone: ( )______________ Work Phone: ( )___________ Fax: _____________Email:
____________________________________ Mobile: _______________________________

Please tick membership type: Single Junior Associate
Membership fees are currently $25 for Junior or Associate Members, and $50 for Adult members.
                             th
Membership expires on the 30 June each year and is due for renewal on or before that date.

Fee: $_________________

Please complete the following:
1. Are you familiar with the Anti Discrimination Legislation? Yes No
2. Have you had a criminal conviction in the past five years? Yes No
3. Can you volunteer some time in or around the Radio
station premises to help keep it running smoothly? Yes No
Your preferences: Announcing Advertising Cleaning Desk
Other Skills: _______________________________________________________________

Do you have Radio Station experience? Yes No
If “Yes” please give details (station, length of service): __________________________________
Preferred times: Days available: ___________________________________________________
Time of day: ___________________________________________________________________

I agree to abide by the Associations Constitution and the Station Procedures and
Guidelines (Parts 1 & 2) and relevant regulations as may be decided by committee.
Signature_________________________________________________Date________________


Proposing Member (New Memberships Only)_______________________________________
New memberships are accepted subject to ratification by committee or appropriate subcommittee.
Return this form and payments to the treasurer at P.O. Box 129 Glen Innes 2370 Phone 6732 1768
Email Address : donnelly@northnet.com.au
Rec. No: _________


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