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Whistleblowers Australia
Appendix 1 to The Constitution:  Application for Membership

Applicant to fill out. Please print clearly

I, ..................................................................................................

of...................................................................................................

........................................................................postcode..................

phone......................................................................................

fax.........................................................................................

e-mail......................................................................................

apply to become a member of Whistleblowers Australia and, in the event of my admission as a member, I agree to be bound by the rules of the association.

I give my permission to release my name and contact information to the national secretary, treasurer and public officer, plus (please tick as appropriate)
... other national committee members.
... office-bearers of my branch.
... contacts or coordinators of subcommittees relevant to my interests.
... any member of the association, at the discretion of office bearers.
... anyone, at the discretion of office bearers.

(Signature)..................................................................   Date..................

Nominator to fill out.

I, ......................................................................................, a member of Whistleblowers Australia, nominate the applicant for membership in the association.

(Signature).................................................................. Date..................

Questionnaire

Information that you provide here may help us match you to relevant contacts or committees. There is no obligation to fill out this questionnaire.

1. Please indicate skills or access to skills by which you can assist whistleblowers, such as secretarial, legal, publicity, financial, research and support skills.

2. Please indicate facilities or access to facilities by which you can assist whistleblowers, such as word-processing, computing, printing and communications.

3. If you are a whistleblower, please indicate what field (health, police, finance, etc.), whether your case is still current, and give a brief outline. Names, places and details are not required if that would create a problem.

Please return this application form with annual membership fee of $25, or sustaining membership fee of $50 (a voluntary, increased supportive fee), plus optional donation of ...............

to The Treasurer, WBA: Unit 1, 5 Wayne Avenue, Marcoola Qld 4564. All members receive a subscription to The Whistle. Whistleblowers Australia depends almost entirely on memberships and donations.

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