Portarlington Business Development Association Inc.  

           	Application for Membership (or renewal of Membership)

To:		
                 The Secretary
	     P.O.Box 318
	        Portarlington  3223

Name:___________________________________________________________

Postal Address:___________________________________________________

_______________________________________ Postcode_________________

Name of Business:________________________________________________

Type of Business:_________________________________________________

Contact Phone No:________________________________________________

E-Mail Address:___________________________________________________

Website:_________________________________________________________


I agree to be bound by the Rules of the Association for the time being in force.



Signature of Applicant:____________________________________________

Dated:_____/______/_________

 

OMy cheque for $70.00 is enclosed OI have transferred the sum of $70.00 by direct transfer to Bendigo Bank Community Branch Limited BSB: 633-000 Account No. 126311745