Membership Form 

I / We wish to apply for membership in the following category (please tick the appropriate box)

Individual member

Circle

Name
Organisation
Tel
Email

Address
Address
State	Please choose QLD NSW ACT VIC TAS SA WA NT N/A
Postcode

Please describe your current involvements and your interest in membership:

                                       I am interested in networks and circles in:

                                       Emergency services units/brigades
                                       Op shops               
                                       Hospitals and health centres
                                       Bushland reserves/national parks      
                                      Older people/ageing
                                       Disabilities
                                       Schools
                                       Other (please specify in the box above)
 

I have the following skills to contribute:

                                       Community networking
                                       Media skills                
                                       Lobbying experience    
                                       Social media skills      
                                      Graphic design skills   
                                       Industrial relations and negotiation skills

  If you are applying as a Circle, please state the purpose of the Circle and the names of the
  nine (minimum) participants:

 
 

MEMBERSHIP CATEGORY	ANNUAL.FEE
Individual volunteer		$5*
Circle of nine volunteers		$18

  * This fee is waived for members of Civil Society Australia. 

Payment Options Please reserve my place and

	I will send my cheque/money order to  Social Enterprise Partnerships
		PO Box 159
		Yarraville Vic 3013
		Cheque payable to Social Enterprise Partnerships
OR

	I will pay by EFT transaction:	Bank: Commonwealth Bank of Australia Account: Social Enterprise Partnerships Ltd BSB: 062 218 Account number: 1007 2945
	Please send a tax invoice.

Terms and Conditions 1. Applications must be accompanied by payment in full, or must request an invoice for payment of the appropriate fee. 2. Payment of this fee is waived for members of Civil Society Australia.