MEMBERSHIP (For full voting rights)

1. MEMBERSHIP(For full voting rights) • Individual Membership (18 to 64 years) $20.00 per person • Honorary members (65 years +) No charge • Financial Year is from1st July 2013 to 30th June 2014 • I, ……………………………………………………………………………………………………… • (NAME IN FULL) • of,…………………………………………………………………………………………………….. • (ADDRESS) (POSTCODE) • hereby apply to be accepted as a member of the Kastellorizian Association of Victoria and • promise, if accepted, to abide by the rules and articles of the Association. • Date of Birth: … /… /…………… Place of birth:…………………………………………….. • Occupation: …………………………………………………………. Married/Single (Circle) • Telephone Nos. ………………………………………….Mobile ……………………………… • . • Email: ………………………………………………………………………………………………. • Father’s name: ……………………………………. Place of Birth: ……………………………. • Mother’s Name: …………………………………… Place of Birth: ……………………………… • If parents were not born in Kastellorizo, please record your Kastellorizian connection : • ………………………………………………………………………………………………………... • Dated this……………………………………….. day of………………………………… 2012 • Signature of Applicant: ……………………………………………………………………………… • Note: If membership renewal please ignore the section below. • Nominated by: ……………………………………………………………………….………………. • Address: ………………………………………………………………………………………………. • Date of Application…………………………… Date of Acceptance: ……………………….. ….. • Secretary: …………………………………………………………………………………………….. • PAYMENT OPTIONS • Mail Kastellorizian Association of Victoria Inc. PO. Box 112 South Melbourne Vic 3205 • EFT transaction at your Bank, Post Office or Internet. BSB: 063014 Account No. 10118932 • Credit Card Download forms from www.kastellorizo.com.au • OFFICE USE ONLY –Receipt No.