Membership Application Form CESH No.(office use only):………………… Please complete this form and return by: 1) email to admin@cesh.org.au 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 ……………………………………………… ………………………………………………. ……………………………………………… ………………………………………………. ……………………………………………… ………………………………………………. I/we have read and undertake to abide by the CESH Terms and Conditions. Signed:……………………………………………………………………. Date:……………………