Additional / Second Vote Membership

Name*

First NameLast Name

Email*

Please provide email that you have used to register this account

Phone Number

Area CodePhone Number

Referred by

Select membership type.

Additional Membership ($100 inc GST)Second Vote Membership ($100 inc GST)

Declaration -

I wish to apply for Membership of NSW Farmers’ Association and agree to be bound to their respective conditions & rules as amended from time to time. I declare that the information I have entered is true and correct.

I declare that the information I have entered is true and correct at the time of signing. I confirm that the class of membership I am applying for is the most appropriate for my circumstances.

Declaration

I agree

FULL PRODUCER DETAILS

Additional & Second Vote memberships need to be linked with a financial Producer membership. Please provide below the details of the Producer members details that your membership will be linked with.

Full Producer Members Name*

Full Producer Member Number

Introduced by

If you have any issues with this form or need assistance, please do not hesitate to contact our Member Service Centre on 1300 794 000, Monday to Friday, 9am to 5pm or contact us using our online form.

Application Form

FULL PRODUCER DETAILS