MEMBERSHIP FORM

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RATEPAYERS ACTION GROUP.

MORETON BAY ASSOCIATION INC.IA37761

NAME: __________________________________________________________________________

ADDRESS: __________________________________________________________________________

HOME PHONE: _____________________ BUSINESS PHONE: ____________________________________

MOBILE PHONE: __________________________EMAIL:________________________________________

I pay rates to Moreton Bay Regional Council for (Circle all types of property that apply to you):

Residential / Commercial / Industrial / Rural

I hereby agree to abide by the objectives, rules & bylaws of the Ratepayers Action Group

Moreton Bay Association Inc.

Memberships(which apply per household): _________ ordinary @ $5 per annum

Applicants Signature _________________________ Date ____/____/____

Proposer's Name: ______________________ Seconder's Name _______________________

Proposer's Signature ____________________ Seconder's Signature .______________________

Date ____/____/____ Date ____/____/____