Members
Application Form
Current Rates Are
Single (s) $60.00 Single Concession (S/C) $48.00
Please note all membership applications need to be approved, payment can be made on approval
MEMBERS APPLICATION FORM
(Please return this portion with payment)
| Name: | __________________________________________ |
| Address: | ______________________________________ ______________________________________ ______________________________________ |
| Phone Number | ( ___ )____________ |
| Type of Member | Single [ ] Single Concession [ ] (Please Tick) |
| Donation | $_____________ |
| Amount Enclosed | $_____________ |
MY CHURCH / FELLOWSHIP / ASSEMBLY IS
NAME AND CONTACT NUMBERS OF MINISTER / PASTOR / LEADER:
APPLICANT SIGNATURE .. DATE ..
BALLARAT GOSPEL RADIO INC.
Po Box 51 Wendouree Victoria 3355
Last Updated: Jan 2011