VIC Active - Membership Application  
Organisations and/or persons wishing to join VIC Active should complete this application form.

The annual membership fee is $220 - this is presently optional given the difficult economic conditions facing many businesses.  You will be offered a membership fee and/or campaign contribution link at the end of this form.  

We appreciate any financial contributions that can be made to support our campaign activities.

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Your organisation's name *
How many individual facilities are you representing *
How many staff do you employ across all facilities *
How many members do you have across all facilities *
How many monthly member visits in total across all facilities? *
Length of operation in years (oldest facility) *
Please provide the suburb names for each of your facilities *
Key person position title *
Key contact person name *
Key contact person email *
Key contact person mobile *
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