Membership Application Form

PO Box 580
Lismore NSW 2480

Please complete the application form and one of our admin staff will be in touch shortly

"*" indicates required fields

Full Name*

Address*

Phone*

Enter Email Confirm Email

I am Identified as:*

Aboriginal

Torres Strait Islander

Neither

Other

If OTHER give details

I am over 18 and Far North NSW Resident*

Over 18

Permanent Resident Far North NSW

Both

Neither

Consent*

I hereby apply for membership according to Schedule 1—Application for membership form Ngunya Jarjum Aboriginal Corporation (ICN 2418)

Date*

Comments

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Acknowlegement