FRIENDS OF COMINOS HOUSE INC
PO BOX 129N, NORTH CAIRNS QLD 4870
ABN 57 054 154 111

APPLICATION FOR- MEMBERSHIP

PLEASE PRINT

Membership is available to individuals ($10 p.a) or groups ($20 p.a)

The Board of Management
Friends of
Cominos House Inc.
PO BOX 129N
NORTH CAIRNS QLD 4870

We hereby make application for Individual Or Group* membership of Friends of Cominos House and enclose a $....... membership fee to 30th June 200....

Should our application be successful we authorise you to place our name on the Register of members and agree to be bound by the Model Rules.

IDIVIDUAL OR GROUP NAME...........................................................................................................

RESIDENTIAL ADDRESS OF CONTACT .........................................................................................

....................................................................................................POSTCODE .....................................

GROUP POSTAL ADDRESS (If applicable).........................................................................................

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

PHONE CONTACT: HOME ....................................WORK..........................................

SIGNATURE.....................................................

POSITION........................................................ DATE ...............................................................

*PLEASE DELETE AS APPLICABLE.

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