BEACON
27 - operated by the
Ph one of our Trustees
Phone 544 7929
MEMBERSHIP
APPLICATION FORM
I / We
Name …………………………………………………………………
…………………………………………………………………
…..……………………………………………………………..
Apply to become a Member of the Nelson Media Access Trust and in
doing so agree
to make an Annual Donation to the Trust to maintain
my membership and
to accept the conditions of membership as set
out in the
Trust Deed.
Telephone
……………………….Fax ……………………...
Email:
…………………………………………………………
Signed:
……………………………………
Date:
………………………………………