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): Constitution 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: 633-000, Acct No; 166 726 042, Reference: Applicant Name Nominator Details - Ordinary Memberships only A current BJI member is required to nominate new ordinary memberships. If you do not know a current BJI member please submit your application without a nominator and we will contact you if we need more information Name of Nominator :
