Permaculture Australia PO Box a1192 Sydney South NSW 1235 Australia ACN 003 386 258 ABN 13 196 156 495 [email protected] Incorporated Membership Application Form Thank you for applying to be an incorporated member of Permaculture Australia to connect your organisation or permaculture enterprise and its membership with the wider permaculture community. Please complete and submit this application form to the email provided. You will be notified as soon as the board has approved the application and will receive instructions for payment and for your nominated representative/s to register on the PA website Full Registered Name of PA Incorporated Entity ADMIN

Type of Incorporated Incorporated Association Company Limited by entity Guarantee (please mark X) Cooperative Trust Other: Company Pty Ltd NB TRUSTS please provide legal name of trustee entity here Incorporation Registration number ABN Charitable status & Registration Number Postal Address Website URL Contact person Name: Position: Email: Phone/Mob: Current number of members/shareholders Provide the required information below to demonstrate your organisation meets at least one of the eligibility criteria for incorporated membership of PIL/Permaculture Australia

1. Permaculture ethics as central to aims and objectives 2. Permaculture practices as central to operations and activities Your organisation’s core Aims or Objectives Your organisation’s main Operations and Activities Provide at least 1 of the Constitution/Rules : listed documents as a Annual Report: PDF, URL or other electronic format or link Newsletter: to current website info URL link: supporting your app. Other relevant information about your organisation, may include geographic area of operation MEMBERSHIP CATEGORY, FEES & VOTING REPRESENTATIVE Select one Incorporated Membership Category Membership Fee (X) Pay yearly Auto Renewal Not-for-profit/NFP with less than 100 members $60 $55 Not-for-profit/NFP with more than 100 members $85 $80 Non-member based or For-profit (profit-sharing) $85 $80 incorporated entity or businesses Preferred method of Direct/electronic Cheque NB Auto renewal payment- deposit attracts $5 discount NB payment to be made Other: after acceptance of application

Nominated Representative/s: NB these may be nominated after the application is accepted

All incorporated member organisations must nominate a representative to vote on behalf of the organisation at PIL/PA meetings and to manage your organisations presence on the PA website. Member-based not-for-profit organisations with more than 100 members may nominate 2 representatives. The representative/s must hold a PDC or APT Cert III or above, and hold a responsible position in the organisation e.g. office bearer, director, committee member, administrator, manager or other position. Name: Representative 1 Position: Postal address: Email: Phone:

Please mark X PDC Teacher: Location: Date: APT APT qualification: Teacher/College: Date/year: Name: Representative 2 Position: (only for NFPs with over 100 members) Postal address: Email: Phone:

Please mark X PDC Teacher: Location: Date: APT APT qualification: Teacher/College: Date/year:

Please email the completed application form to: [email protected]