Darumbal CYS | Rockhampton | Membership Form

Membership Type *

New Membership‎
Membership Renewal‎

Membership Details *

Aboriginal or Torres Strait Islander‎
Other Ethnicity‎
Aboriginal or Torres Strait Islander - under 18‎
Other Ethnicity - under 18‎

Name *

First

Last

Date of Birth *

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Phone *

Email

Do you consent to receive information from DCYSI via email?? If yes, please enter your email address.

Email

Payment options *

Cost is $5.50 (incl. GST).
Bank deposit is preferred to: BSB 633-000 Acc 127843118. Please use MEMBERSHIP - (name) as the reference.

Checkboxes *

Bank Deposit: ____________________________________(receipt number & date)‎
Cheque‎
Cash at Office‎
Pay on Invoice: ___________________________________(email address)‎
Payroll deduction (current staff only)‎

Member Declaration *

By ticking the box below; I agree to pay the annual membership fee as determined by Darumbal Community Youth Service Inc. and to keep the organisation up to date of any change of details relating to my membership. I further accept any and all decisions the Committee of Management makes in regards to this application and understand there is a procedure for appeal to the Committee in writing, within one month of acceptance or rejection notice.

I have read and agree to abide by the membership terms and conditions.‎

Community Engagement

Membership Form

Community Engagement

Membership Form

Email

Payment options *

Member Declaration *