MEMBERSHIP APPLICATION FORM

Please complete the form below making sure all fields in bold are filled in to submit your application for membership. This information will be used to process your application for membership only as per Australian Privacy Laws.

Full Name:
Business Name:
Street:
Suburb:
Postcode:
Phone No:
Mobile Phone:
Fax No:
Email:
	(a valid email address is required to ensure receipt of information from the SBCCA)
Website Address:
	(to be included in www.southlakemac.com Business Directory Listings)
Membership Fees:	Business ($66) Community Organisation ($22) Individual ($11)
By clicking the "Send Application" button below I hereby apply to become a member of SBCCA. In the event of my admission as a member, I agree to be bound by the rules of SBCCA for the time being in force.