LGEMA Membership Application

Applications for membership will be considered by the Committee.

Elected member fee $60

Former elected members are free

Associate membership is $100

Upon receipt of the following information, we will provide banking details for payment by return email.

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Name *

First

Last

Email *

Note: An address which is not your elected member address.

Best contact number *

Postal address *

Which local government district are you from? *

address Do Which

Which local government office do/did you hold? *

What is/was your term of office? *

Which LGEMA member is endorsing your application. *

Note: If you do not have an endorsing member please contact enquiries@LGEMA.og.au to discuss.

Has your LGEMA membership been paid?

• Yes
• No

Have you read the LGEMA Rules of Association on our Home Page?

• Yes
• No

Will you uphold the LGEMA Objectives and Purpose

• Yes
• No

Do you have any particular qualifications/expertise you can offer LGEMA? *

Signature of Agreement *

Note: Stating your name in this box confirms acceptance.

Submit