Application forOrdinary Membership ($10)Friends of the Jetty (Associate) Membership ($5)Applicant's DetailsGiven Name(s) : Surname : Address Details Residential Street Address : Suburb : Postcode: State: Contact Information Contact Number: Email: Occupation (if retired, prior to retirement): Retirement Date (if retired): ConstitutionI, wish to apply for membership of the Busselton Jetty Inc. and agree to abide by its Constitution and to promote its objectives. I understand that a copy of the Busselton Jetty Inc. Constitution is available to me on request to the Association's Secretary.Membership FeeOrdinary Member - $5 Application Fee + $5 Annual Fee = $10Friends of the Jetty (Associate) Member - $5 Application Fee, No Ongoing FeePlease pay by Direct Credit to:Acct Name: Busselton Jetty Inc,BSB: 036-123,Acct No; 380167,Reference: Applicant NameNominator Details(Current Busselton Jetty Inc. Members Only) Name of First Nominator : Name of Second Nominator :
