Apply for Membership - Port Phillip Community Group

Membership Application or Renewal

Full Name

Postcode

Phone Number

Date of Birth

Gender

Ethnicity

Do you identify as Aboriginal or Torres Strait Islander?

Yes No Prefer not to say

What language(s) do you speak?

If applicable, name of referee:

If you answer other

Which membership are you applying for?

The reason I want to become a member is:

As a member, what do you think you could contribute to Port Phillip Community Group:

I wish to become a member / renew my membership of the Port Phillip Community Group and:

I certify that I am over 18 years of age and am either a participant of the Port Phillip Community Group or that I reside, work or study in the City of Port Phillip

Confirm that the above details are correct

Agree to be bound by the Rules of the Company

Have read and agree to support the Statement of Purpose of Port Phillip Community Group

Agree to pay $2, which entitles me to membership for one year and voting rights at the Annual General Meeting and any other special meetings which may be called

Signature

Date

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Our Locations

St Kilda

161 Chapel Street
St Kilda 3182

T: 8598 6600
E: info-support@ppcg.org.au

Port Melbourne

333 Bay Street
Port Melbourne 3207

T: 8598 6600
E: info-support@ppcg.org.au

Alma Road

200 Alma Road
St Kilda East 3183

T: 9525 8746
E: arch@ppcg.org.au

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