Associate Member Application Form

Associate Member Application Form
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Occupation
Date of Birth
Email
example@example.com
Have you ever been a previous member of Radio Logan 101FM or any other community or commercial radio organisation?

Yes No
If you answered yes, please give brief details
In which area do you wish to become an active member?

Admin Reception Presenter Events
I am willing to undertake a National Criminal History Check, at my cost, which will be payable directly to Queensland Police. I will then supply the report to the station manager.

I will support Radio Logan Incorported with it's aims and objectives in the community and agree to be bound by the rules, code of conduct and by-laws of the association. I also understand that my membership with Radio Logan Incorportaed is a voluntary and non-paid position.

If requested by the station manager, character references may be required with this application.

Membership (when accepted) enables you to apply for an active role in the association. It also enables you to vote (when eligible) and to participate in all assigned station activities and to attend all general meetings. Membership does not confer any rights to use the station broadcasting facilities without authorisation of the station manager or management committee.
Name of Applicant
Date
Age (If under 18 must be signed by parent or guardian)
Existing 101FM member proposing the application
Do you know the applicant?
If your answer to above question was Yes, for how long?
Existing member seconding this application
You may be required to call into the station to sign the application.
My Products

Individual Member Joining Fee & Annual Fee $ 102.00 AUD

Family/Co Partner Joining Fee and Annual Fee $ 125.00 AUD

Concessional Member Joining Fee and Annual Fee $ 80.00 AUD

Concessional Family Joining Fee and Annual Fee $ 100.00 AUD

Total $ 0.00 AUD

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The payment is ready! It will be completed once you submit the form.
If you prefer to pay by direct deposit the details are as follows:

Name: Radio Logan Incorporated

BSB:633 000

Account: 151732997

Please send an email to reception@101fm.asn.au advising of your payment.
Should be Empty: