Contact Details *

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Business Hub Membership Category *

Memberships are valid for the Financial Year - 1 July to 30 June.

Associate C4P Members $200 (Must be a Financial member of the Committee for Portland)

Community Group $300

Business $400 (ABN)

Government Body $500

Payment Options *

Payment to be made to: Committee for Portland BSB 325-185 Account No. 70131394

Tax Invoice

Direct Deposit (Note name, Hub hire, Invoice number)