Melbourne Wireless / members / join?stage=2&r=1

Melbourne Wireless Inc.

Membership Application Form

Required Information
To be recorded in the 'Register of Members'
First Name:
Surname:
Address:

Suburb:	State:	Postcode:
Email:

Optional Information
For the sole use of the Committee
Occupation:
Birthdate:	day:month:year:
My skills include:
I heard about MelbWireless:
I expect from MelbWireless:
It would be nice if MelbWireless:
I'm also a member of:
I expect to spend __ on wireless equpiment in the next 12 months:	$
Any other comments?

Payment Information
I wish to apply for: year membership @ $50/year
Membership Card:

Site account information
Username:
Password:
Confirm Password:

Melbourne Wireless Inc. undertakes to honour or exceed the legal requirements imposed on us by law, including but not limited to the Australian Privacy Act 1988. Should you feel we have not met our obligations or you have questions regarding this application then contact us as soon as possible by sending e-mail to committee@wireless.org.au with details.

Node Statistics
building	132
gathering	192
interested	515
operational	242
testing	216

Melbourne Wireless Inc.

Membership Application Form

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