APPLICATION FOR MEMBERSHIP OF ASSOCIATION 

 

Business West Wyalong Incorporated 

(incorporated under the Associations Incorporation Act 1984) 

 

Please print clearly in block letters using a black pen for easy copying. Thank you. 

 

I, ....................................................................................................................................... 

(full name of applicant) 

 

of ...................................................................................................................................... 

(Business Name) 

Business Details 

 

............................................................................................ 

(Position in Business – owner/manager/partner etc) 

 

......................................................................................................................................... 

(Business Address) 

......................................................................................................................................... 

(Postal Address if different from above) 

 

Phone..............................................................Fax............................................................ 

 

Email.........................................................@.................................................................... 

(Business contact information) 

 

Mobile Phone........................................................................I do/do not want text reminders 

 

 

hereby apply to become a member of Business West Wyalong Incorporated. In the event of 
my admission as a member, I agree to be bound by the rules of the association for the time 
being in force. 

 

.......................................................... ....................................... 

Signature of applicant Date 

 

 

 

Please send to: P.O.Box 349, WEST WYALONG NSW 2671 

Office Use only:- 

Business West Wyalong Inc Membership No. ................................. 

$10 ........................ Joining Fee (New Member Only) 

$50........................ Annual Membership Fee 

Paid by:- Cheque CASH Reciept No................................... 

Entered into database by:- .........................................Date : ...........................