JOIN CIBRA

APPLICATION FORM

Chevron Island Business and Residents Association Inc.

Contact for more info Geoff Smith President 0414441468 or Silvana Karupovic 0418108196

MEMBERSHIP APPLICATION 2019 / 2020 – NEW MEMBERS

I wish to join the Chevron Island Business and Residents Association Inc.Name: ____________________________________________________

Business: __________________________________________________

Address: ____________________________________________________

Phone: _______________________ Fax: __________________ Mobile: _______________________

Email: ______________________________________________    

Website Address (if applicable): ______________________________________

ACN/ABN: _______________________________

Short description of my business (max 100 words) _____________________________________________

_____________________________________________________________

I have emailed a photo of my business / product to: clivehaddow@yahoo.com.au           ð   Yes    ð   No

I hereby apply for membership of Chevron Island Business and Residents Association Incorporated, and if accepted, I agree to be bound by, and to comply with the Constitution, Rules and Articles of Association for the time being of the said Chevron Island Business and Residents Association Incorporated.  I acknowledge that details supplied above may be used within the organisation only for contact between members.

Nominated By: …………………………………………….  Seconded By:  ………………………………………………………..

Signature of Applicant:  …………………………………………………….  Date Signed: _ _/ _ _/ 20 _ _

Membership Fee: $50 for businesses and $5 per person for residents (1st July to 30th June)

NOTE – Businesses will be included in video on our You Tube channel as part of membership

I want to join as   Business            Resident 

I would prefer to pay by (please tick your option):

  • Enclosing a cheque
  • Enclosing cash            (Only use this option if handing your membership to a committee member)
  • Direct Deposit (Details as below)

Bank Name:               Bendigo Bank Ltd, 2/65 Thomas Drive, Chevron Island QLD 4217Account Name:         Chevron Island Business and Residents Association Inc BSB:                           633-000A/c Number:              151625001 Reference:  (Your business or trading name)

Please return your Membership Renewal Form to a Committee member or mail to CIBRA C/- PO Box 37, Chevron Island QLD 4217 or fax to 07 5570 3225 or scan / email it to clivehaddow@yahoo.com.au or silsk@icloud.com

Chevron Island Business and Residents Association Inc. Use Only:

Payment receipted on: ___________________               Receipt No: ____________

Payment deposited on: __________________

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