Membership Application Form
CESH No.(office use only):…………………
Please complete this form and return by:
1) email to [email protected]
2) post to Toni McLean, 31 Valetta St, Moss Vale, NSW 2577.
.
Name: ……………………………………………………………………………………………………
Residential address: …………………………………………………………………………….……..
Town: ………………………………………………………………….. Postcode: ………………..…
Mailing address (if different): …………………………………………………………………….……
Town: ………………………………………………………………….. Postcode: ………………..…
Home Phone: ………………………………….. Mobile: ……………………………………….……
Email address: ………………………………………………………………………………………….
Type of membership (tick as appropriate):
All memberships are lifetime, providing you trade at least once every two years.
 Individual: $10 plus ann. fee 10 Gibs
 Shared (Family or Household): $15 plus ann. fee 30 Gibs
 Organisation (Community Group or NGO): $20 plus ann. fee 40 Gibs
 Business: $30 plus ann. fee 40 Gibs
 Once only additional fee for non-internet based membership: add $20 to the appropriate fee
above to cover extra administration, printing and postage costs (for those in receipt of a government
benefit, the additional fee is $10).
Payment type:
 Cheque
 Money Order
Made payable to Community Exchange Southern Highlands
OR
 Direct Deposit
 Internet Transfer
Please remember to include your name in the transfer details.
Bank: Westpac
BSB: 032716
Account Name: Community Exchange Southern Highlands
Account Number: 286952
 I do not want to be included in the CESH email newsletter list.
Services/Goods I/we can offer to other members
………………………………………………
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………………………………………………
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I/we have read and undertake to abide by the CESH Terms and Conditions.
Signed:……………………………………………………………………. Date:……………………
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Membership Form - Community Exchange Southern Highlands