Opt-in form for Clubs and Groups

To be eligable, the Community Group or Club must be a not-for-profit organisation, a current customer of an Community Bank Upwey & District or Emerald & District and must opt-in via this form.

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* 1. Name of Eligible Community Group or Club

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* 2. Name of contact person:

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* 3. Telephone Number

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* 4. Address:

Full Terms and Conditions can be found here:
Terms and Conditions - Community Bonus Program

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* 6. I agree to opt-in on behalf of the above Clubs or Group.

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* 7. Date:

Date

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* 8. Signature:

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* 9. I acknowledge that by entering my name above I am providing a digital signature.

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