Registration Membership Level*Basic MembershipSupporter (A supporter is someone who lives outside the Great Lakes area)OrganisationAre you a New Member or Renewing your Membership*I am a new MemberI am renewing my membershipTotal $ 0.00 Personal DetailsEmail Address* Enter Email Confirm Email Your Title*MrMrsMissMsPlease provide your Full Name:* First Last Primary Address* Street Address City State Postcode Postal Address* Same as above Street Address City State Postcode Phone/Mobile Number*Work Number (if applicable)Would you like to volunteer?*YesNoWhat skills or interests would you like to provide to the station?*Membership Consent* I do hereby make application to become a Member of Great Lakes Area FM Community Radio Association Incorporated and request you to enter my name on the Register of Members. If accepted, I certify I understand and abide by the Constitution and all other rules of the Association. I, the above named nominee, do fully understand that I cannot be elected as a Member of the Association until the Committee Management meeting following the expiration of fourteen days (14) from the date hereon. In support of my application, I confirm that I am a resident of the area that was previously administered by Great Lakes Council. Note: it is a requirement of the Australian Communication and Media Authority (ACMA) that only those who reside in ACMA Radio Area Forster RA1 can be members of the Association , Forster RA1 as defined by ACMA and the Great lakes Council Boundary are the same.Payment DetailsCredit Card - Secure Payment American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Help us to combat spam!CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.