Membership form

I am applying for membership of the Prostate Cancer Support Group — ACT Region and agree to abide by the Rules of the Group, encapsulated in the Group’s Constitution and subordinate rules and procedures.

Note:
Member’s details are privacy-protected and solely used by the Group’s Executive for administration of the Group in accordance with the Associations Incorporation Act 1991 (ACT). Your details will not be used for any other purpose unless agreed by you in writing.

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Membership

Category of membership being applied for:(Required)

Member - with voting rights

Inactive member - not to be counted for quorum purposes

Auxiliary member - Wives or Partners

Title

Given Names(Required)

First Last

Your Address

Street Address Suburb City State Post Code

Contact Details

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Your Email Address(Required)

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