Group Membership Application

An approved group is entitled to ONE vote. The representative acts as the contact person and is entitled to cast a vote on behalf of their group. A Group may consist of people with a common interest, a community based organisation, local government authority or state government agency.

 

Please complete the form below.

Are you an .. Please select one (required)

Name of Nominating Group / Organisation (required)

Name Of Representative (required)

Name of Authorised Officer (required)

Position of Authorised Officer (required)

Residential Address (required)

Postal Address if different from above

Phone Number (required)

Your Email (required)

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