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Membership Application Form
Brooks Area Community Group Incorporated Society

Our groups email: brooksacg@gmail.com

The information collected here will not be shared
It will only be used on our membership register and not made available to others

Email address *
Membership options
There are two levels of membership available.

Individual Membership: $10 per financial year or part thereof. (One member, one vote, one newsletter)

Household - two Memberships: $15 per financial year or part thereof. ( Two members, two votes, two newsletters)

Select your membership preference *
First Name 1 *
Your answer
Surname 1 *
Your answer
Mobile 1
Your answer
Home Phone 1
Your answer
First Name 2
Your answer
Surname 2
Your answer
Email 2
Only enter if email is different from the one at the top of the form
Your answer
Mobile 2
Your answer
Home phone
Only enter if it is different from the one you entered under Home Phone 1 question above.
Your answer
Brooks Area Residential Address *
Your answer
Mail Postal Address
If different from Brooks Area Residential Address or a P.O. Box number
Would like to be more involved ?
Please let us know how you would like to help... time... skills... contacts
Your answer
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