Membership Nomination

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* 1. I wish to nominate to become a member of RSPCA Victoria!

Adult Membership 2021-22

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* 2. Please enter your details:

First Name

Surname

Email

Phone

Address

Suburb

State

Post Code

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* 3. Are you affiliated with any other organisation or interest group? (As a member, staff, donor etc.):

Yes

No

If yes, please specify any affiliations

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* 4. I agree to accept and abide by the Constitution and Rules of RSPCA Victoria.

I agree that I am over 18 years of age and understand my rights and responsibilities as stated in the RSPCA Victoria Constitution.