Application for membership of CCBR

Join the group - help make a difference

First Name

Last Name

Please enter your email address. We will contact you via this address to confirm your membership once the payment has been received. Please allow a few days for this as it is not an automated process.

Postal Address

Postcode

Phone number

Comments or questions

Method of payment

Preferred method of payment is by Direct Transfer to our account:

Bendigo Bank, BSB 633-000, a/c 127362408, "Climate Change Balmain-Rozelle"

Please identify your membership payment with your full name.

Alternatively, please mail a cheque to CCBR at PO Box 890, Rozelle, NSW 2039.

Amount

Membership is $30 per year. Your extra donation is very welcome. Please enter amount of transfer here.

Existing or renewing?

I am a current member, RENEWING my membership

(Tick if you are an existing member, leave blank if you are joining.

Membership agreement

By entering the code below, I confirm that I am paying a subscription to become a registered member of CCBR for the next twelve months using the payment method shown above. I understand that this gives me voting rights at members' meetings including the AGM, and qualifies me to be elected as a committee member or officer if I wish.

Enter the code below in here: