December 2017 Newsletter

Page 16

Christmas Office Closure

12:00pm 22 December 2017 till 8:30am 2 January 2018 Newsletter: December 2017

Page | 16

ORDINARY MEMBERSHIP APPLICATION FORM I would like to apply for Ordinary Membership of Independent Advocacy in the Tropics Inc. Ordinary membership shall be open to all interested persons in the community who support the mission and objects of the Association who apply for, and accepted for membership of the Association.

Name: Address:

Email: Phone:

Date of Birth: ☐ Yes

Do you identify as a person with disability?

Signed:

☐ No

Date:

On completion, please return to the Secretary. 2/179-181 Ross River Road MUNDINGBURRA QLD 4812 PO Box 3067 HERMIT PARK QLD 4812

Phone: 1800 887 688 07) 4725 2505 Fax: 07) 4725 6106 E-mail: admin@iat.org.au

OFFICIAL USE ONLY Proposed by:

....................................................

Signed: ......................................

Seconded by:

....................................................

Signed: ......................................

Accepted by Meeting of the Management Committee. Date of Meeting: ...............................................


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