new membership form (PDF)

GUJARATI ASSOCIATION OF VICTORIA INC.
P O Box 1112, Blackburn North, VIC, 3130.
1 January 2013 to 31 December 2013
APPLICATION/RENEWAL OF MEMBERSHIP (please circle)
(Refer to Rule 8 of the Constitution )
PLEASE CAREFULLY READ THE FORM INCLUDING NOTES BELOW.
IMPORTANT: ALL DETAILS MUST BE COMPLETED.
INCOMPLETE FORMS WILL NOT BE ACCEPTED.
First Names:

____________________________________________________Surname:________________________

Address:

____________________________________________________________________________________

Suburb:

____________________________________________________________________________________

Post Code:

______________________________________________________________________________________

Home Tel

_______________________________

Mobile

_______________________________

Work Tel ______________________________________

Email Address: ___________________________________________________________________________________
Year of Birth

|__|__|__|__|

Gender: M / F (please circle)

(Refer to Rule 5 of the Constitution for Class of Membership)
Details of all family members:
Full Name

Relationship to applicant
(Please tick appropriate box for each)

Year of Birth

Spouse
Names of Dependents

Son

Daughter

Others (Specify)

I / We would like to receive electronic communications from GAV at the above email address.
Yes or No
(Please circle)
I / We would like my details (excluding email address) published in the GAV Directory.
Yes or No
(Please circle)
I/we have read and agree to abide by the rules and regulations of GAV at all times.
Date:

_______________________

Signature of Applicant: ______________________________________________

Application referred by the following GAV financial member: (Only for New Applicants)
Name of Financial Member:______________________________
Membership of above new applicant is
By GAV Management Committee

Signature:_________________________________

Approved / Not Approved
Date: