RQ Application for Membership Question Title * 1. Contact Details Full Name Address Address 2 City/Town State Post Code Country Email Address Phone Number Question Title * 2. Are you from a Culturally or Linguistically Diverse Background? Yes No Prefer not to say I don't know Question Title * 3. Do you identify as Aboriginal and/ or Torres Strait Islander? Aboriginal Torres Strait Islander No Prefer not to say I don't know Question Title * 4. I confirm that I agree to become an ordinary member of the Company and to be bound by the Constitution of Roseberry Community Services Limited. I will be invoiced the amount of $10.00 upon my paperwork being processed. I agree Question Title * 5. New memberships require support of two (2) existing members. Please note their names below. Proposed by member name Seconded by member name Done
