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Jika Jika Community Centre Inc.

Membership Application Form

The form needs to be printed off and returned to:
Jika Jika Community Centre Inc.
P/O Box 2
Northcote 3070

I agree with the Aims and Objectives of the Jika Jika Community Centre Inc. as stated in the Constitution of that organisation and to work towards them.

NAME:                           _____________________________________________________

ADDRESS:                   _____________________________________________________

                                        _____________________________________________________

                                        _____________________________________________________

POSTCODE:                 _____________________________________________________

TELEPHONE:               (Home):     _____________________________________________

                                         (Work):     _____________________________________________

                                       (Mobile):     _____________________________________________

SIGNATURE:                 _____________________________________________________

DATE:                             _____________________________________________________

 

Please note this Membership Form is only valid if it has been returned to the Centre Office.