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 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Help us to combat spam!NameThis field is for validation purposes and should be left unchanged.