BMT (Byron Mullum Tweed) LETS. Northern Rivers NSW

MEMBERSHIP APPLICATION FORM

Byron Mullum Tweed LETS
MEMBERSHIP APPLICATION FORM
Please send To:
The Secretary, BMT LETS, PO Box 640,

Mullumbimby, 2482.
Phone: 0402 821 579

For Office Use Only 01/02/03

Membership No

Renewal M/S

Office Location: 44 Beech Drive, Suffolk Park 2481
Office Day: Wednesday 10am -3pm

First Name: ............................................ЕЕЕ..Е... Surname: ............ЕЕЕЕЕ............................................

Preferred or Spiritual Name (if different from above): ...........ЕЕ.ЕЕЕЕЕЕ..........Е... Sex: o M o F

Business / Organisation Name for Directory (if applicable): .....Е............................................................................

Postal Address: .................................................................................................................................ЕЕЕ............

........................................................................................ЕЕЕ.......... Post Code: ......................

Residential Area : ....................................................................................................................................ЕЕЕ......

Phone Numbers (Please■ which number to be included in Directory)

Home: o .......................ЕЕ..................Е....Е Mobile Number: o ...................Е....................Е..Е.....Е.

Fax: ...................................ЕЕ......ЕЕЕЕЕ. Email: ...........Е..ЕЕЕ.......................ЕЕ............ЕЕ...Е.

I have been a member of another LETSystem: oYes o No - If Yes, Which one: ..........................ЕЕ....Е..

Skills /Services /Products offered - for which you will accept Ecos. (See Directory listings for Category)

Skills Recognised Qualification. Category (One per Skill)

1. ........................................................................ o Y o N................Category: ...............................................Е

2. ........................................................................ o Y o N................Category:.................................................Е

3. ........................................................................ o Y o N................Category: ................................................Е

4. ........................................................................ o Y o N................Category: ................................................Е

AGREEMENT - I wish to join Byron Mullum Tweed LETS and Enclose:
(Please Tick) o $25 (dollars) & 5 Ecos (Ecos will automatically be debited monthly) Ц Membership Fee
NB. I understand this amount is not refundable.
*I have read and will abide by the Byron Mullum Tweed LETS Membership Agreement. (see reverse side)

Signature of applicant: ..................................................................................Е.... Date: .........../............/..........

FOR OFFICE USE ONLY:

o Money Order No:.................Е...............Е. o Cash: $ЕЕ.ЕЕЕ. o Cheque No: ...................................

Date Received: .Е..Е...../.Е........./ЕЕЕ... Receipt No: .............................Е.....ЕЕЕЕЕЕЕЕЕЕ..

Signed Up By-(1st Name & No): ...................................... Data Entered By - (1st Name & No): ..........Е................

This page developed by Roslyn Brown for Byron/Mullum/Tweed LETS
Created on March 16, 2005 and last updated on August 06, 2006
For feedback on this site or additional links please
BMT LETS Email

Byron Mullum Tweed LETS MEMBERSHIP APPLICATION FORM Please send To: The Secretary, BMT LETS, PO Box 640,

Mullumbimby, 2482. Phone: 0402 821 579

For Office Use Only 01/02/03

Renewal M/S

Byron Mullum Tweed LETS
MEMBERSHIP APPLICATION FORM
Please send To:
The Secretary, BMT LETS, PO Box 640,

Mullumbimby, 2482.
Phone: 0402 821 579