APPLICATION FOR MEMBERSHIP OF:
Anti-Violence Project of Victoria Inc.
I support the mission, statement
of philosophy, and objects of the Anti-Violence Project of Victoria Inc.
AND I wish to become a member.
In the event of my admission
as a member, I agree to be bound by the Rules of the Association for the
time being in force.
I enclose my annual membership fee of :
I would like to contribute an additional donation of $_____________ to the AVP.q $5.50 (Unemployed, concession)
q $11.00 (Full Time employed)
q $22.00 (Organisations)
Name: ___________________________________________
Mailing Address: ___________________________________________
________________________ Postcode: __________
Telephone: Home: ________________________ Work: ___________________________
Fax: ________________________ Email: _____________________________
Preferred method of contact (please tick one or more of the following): q Mail q Email q Fax
SIGNED: ______________________________________
DATED: ______________
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I, ...............................…………….........
, a member of the Anti-Violence Project of Victoria, nominate the
applicant, who is personally known to me, for membership of the Association.
SIGNED: ______________________________________
DATED: ______________
| Office use only:
Received: / / New membership accepted: / / Receipted: / / Entered on register: / / |