Membership Application - Conservation Council ACT Region

Organisation Name(Required)

Organisation Email(Required)

Organisation Phone(Required)

Organisation Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organisation Website

Number of Supporters

Approximate.

Reason for applying for Membership

Please describe the reasoning behind becoming a Member Group (eg. booking the CCACT office, collaborating with us/other member groups etc.)

How do the values of your organisation align with the values of the Conservation Council?

Please provide a brief description

How does your group meet the requirement of being a not for profit organisation based in, or with a presence in the ACT Region?

Member Groups of the Conservation Council are required to be a non-profit organisation with a defined presence in the ACT region.

Constitution/Mission

Max. file size: 49 MB.

The Board considers and must approve membership of the Conservation Council so please enclose your Constitution if incorporated or attach a brief statement of the mission, aim or objectives of your organisation.

Membership Fees

Membership is open to organisations with at least ten members, whose primary objectives include environmental conservation or protection. Member organisations are entitled to appoint nominated representatives, with voting rights. The Conservation Council Board is responsible for considering and approving each membership application. Once your application has been approved you will be contacted about payment of the membership fee and provided with details on how to do so. Annual fees are GST inclusive and vary depending on the number of members in the organisation. Memberships are renewed every financial year and member organisations will receive a renewal notice via email at the beginning of each financial year. Annual Membership Fee (Incl. GST): Under 50 members = $75; 51-100 members = $120; Over 100 members = $140; Complimentary membership = Waived.

Number of Members(Required)

under 50

51-100

Over 100

Complimentary

Representatives to Council: Under 50 members = 1 representative 51-100 members = 2 representatives Over 100 members = 3 representatives Complimentary = Nil

Payment Options

Online payment via credit card; Bank transfer; Cash or cheque.

Nominated Representatives

Please refer to number of members above to determine the appropriate number of nominated representatives for your organisation. These people are your representatives at General Meetings of the Conservation Council. We ask that you nominate representatives who are able to stay in touch via email updates and act as a communications link. It might be useful to fill in three names whatever your level of representation as email correspondence and our email newsletter will be sent to these representatives.

Representative 1 (Main representive and primary contact)

Name(Required)

First Last

Position(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Representative 2 (Medium and Large Groups only)

Name(Required)

First Last

Position

Email(Required)

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Representative 3 (Large Groups only)

Name(Required)

First Last

Position

Email(Required)

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Member Group Application Form

Membership Fees

Payment Options

Nominated Representatives

Representative 1 (Main representive and primary contact)

Representative 2 (Medium and Large Groups only)

Representative 3 (Large Groups only)