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Online Membership Form

Application for

Ordinary Membership ($10)Friends of the Jetty (Associate) Membership ($5)

Applicant's Details

Given 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):
I, 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 Fee

Ordinary Member - $5 Application Fee + $5 Annual Fee = $10

Friends of the Jetty (Associate) Member - $5 Application Fee, No Ongoing Fee

Please pay by Direct Credit to:

  • Acct Name: Busselton Jetty Inc,
  • BSB: 036-123,
  • Acct No; 380167,
  • Reference: Applicant Name

Nominator Details(Current Busselton Jetty Inc. Members Only)

Name of First Nominator :

Name of Second Nominator :