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..................
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.
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Please return this application form to the Treasurer, Feliks Perera, at feliksfrommarcoola@gmail.com or by post to 1/5 Wayne Avenue, Marcoola QLD 4564.
The annual membership fee is $25. You're welcome to add an optional donation.
Make your payment in one of these ways:
1. Pay Whistleblowers Australia Inc by online deposit to NAB Coolum Beach BSB 084034 Account Number 291738485. Reference your surname.
2. Pay by credit card using PayPal to account name wba@whistleblowers.org.au. Use your surname/membership as the reference
All members are entitled to a print subscription to The Whistle.
Whistleblowers Australia depends almost entirely on memberships and donations.