Portarlington Business Development Association Inc.  

           	Application for Membership (or Renewal of Membership)

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

Name of Business:________________________________________________

Postal Address:___________________________________________________

_______________________________________ Postcode_________________

Address of Business(if different):____________________________________

_______________________________________ Postcode_________________

Type of Business:_________________________________________________

Contact Phone No(s):______________________________________________

E-Mail Address:___________________________________________________

Website(if any):___________________________________________________

Name of Business Owner or representative:__________________________

Name of Spouse or Partner:________________________________________
(optional - for invitational purposes only)

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