PICQ Membership Application

PACIFIC ISLANDS COUNCIL QLD | MEMBERSHIP FORM
Mission: Represent the voice and views of Qld based Pacific Island national organizations.
The Pacific Islands Council Qld is a non-profit community incorporated association managed by volunteer representatives of member community groups and individuals who believe in the collective voice for the benefit of all Pacific Islanders

To become a member, please take a moment to fill out this form and attach a copy of your membership-fee deposit receipt.

If you have any problems completing the form please don't hesitate to contact us at info@picq.com.au
Which type of membership would you like to apply for?*

Individual Annual Membership -$20Association or Group Annual Membership- $100Association or Group Annual Membership + Public Liability Insurance -$250
If applying for a Association or Group Membership
Name of Association or Group
Amount Due $
Deposit to BSB: 484799 |Acct: 602063280
Title*
DOB*

MonthDayYear
Name*

First NameLast Name
Address
City
State
Area Code
Pacific Island Country of Affiliation*
Phone*
E-mail*
example@example.com
PICQ has various Networks. Which of the following would be areas of interest?

Climate ChangeJusticePICQ YouthPacific Women's AlliancePacific Church Leaders Network
Upload copy of deposit receipt*

Cancelof
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