Individual Membership Application Form

Full Name *

Preferred Name (if different)

Date of birth *

Address *

Street Address

City

State

Country

Postal code

Email *

Phone *

Preferred Contact Method

Email

Phone

Are you interested in volunteering with us? Do you have any specific skills, experiences, or interests you would love to contribute to the hub?

Please review and sign the Membership Agreement. Once done please tick to acknowledge.

By signing below, I agree to abide by the Constitution and Guiding Principles of Entelechy Living and confirm that the information provided in this application is accurate to the best of my knowledge. I understand that membership is subject to approval by Committee, and the Association reserves the right to reject applications in accordance with its policies.

I also agree to pay the relevant membership fee upon approval of my application.

Signature of Applicant *

Clear

Membership Fee *

Annual Membership Fee

Subscription

AU$45