Membership Application Form Full Name: ______________________________________________________________________________ Residential Address: (Not a P.O. Box)_______________________________________________________ Postal Address:__________________________________________________________________________ Telephone: (A/H)_______________________________ (Mobile)________________________________ Our preferred method of communication for toy library duty rosters and other mail-outs is via email. Is this an option for you? NO / YES - Email address: __________________________________________________________________________ Number of children of borrowing age (0-6 yrs): ________ (Family daycare educators and group members use average number of children in care.) Names DOB ___________________ ___/___/___ ___________________ ___/___/___ ___________________ ___/___/___ ___________________ ___/___/___ ___________________ ___/___/___ Type of membership: Amount Paid Temporary Gift certificate __________(payment due on _____________) Ordinary (full year) $45.00 __________ Concession (full year) $35.00 __________ (please show proof of concession) Grandparent/Limited $20.00 __________ Family Day Educators $60.00 __________ Group Membership $60.00 __________ 6 month m’ship $ 25.00 __________ We invite you to join our committee, as many hands make light work (and it is a great way of getting to know other members and the toy collection!). Would you be interested in joining our committee at some stage? YES NO I apply for membership of the Echuca Moama Toy Library and agree to comply with its rules and to indemni- fy the Echuca Moama Toy Library, its members and staff against all loss, liability, injury or damage, however caused, arising from borrowing by or through me, of any toys, games or other items. Date: ____/____/____ Signature: _________________________ Please show some form of identification with current address (e.g. driver’s license) New members: How did you hear about toy library?_________________________________ Availability for roster: (circle all that apply or indicate preferences) Tuesday 10:30 – 11:30 a.m. Saturday 10:30 – 11:30 a.m. No preference Amount Paid $ ______________________ ID sited: YES/NO License No:______________________ Signature of roster committee member:______________________ Date: _________________ Echuca-Moama Toy Library inc, ABN 43202095720 P.O Box 13 Moama 2731, 34-36 Heygarth Street Echuca, [email protected]
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Membership Application Form Full Name: ______________________________________________________________________________
Residential Address: (Not a P.O. Box)_______________________________________________________
Postal Address:__________________________________________________________________________ Telephone: (A/H)_______________________________ (Mobile)________________________________ Our preferred method of communication for toy library duty rosters and other mail-outs is via email. Is this an option for you? NO / YES -
Email address: __________________________________________________________________________
Number of children of borrowing age (0-6 yrs): ________
(Family daycare educators and group members use average number of children in care.)
Names DOB
___________________ ___/___/___
___________________ ___/___/___ ___________________ ___/___/___ ___________________ ___/___/___ ___________________ ___/___/___
Type of membership: Amount Paid
Temporary Gift certificate __________(payment due on _____________)
Ordinary (full year) $45.00 __________
Concession (full year) $35.00 __________ (please show proof of concession)
Grandparent/Limited $20.00 __________
Family Day Educators $60.00 __________
Group Membership $60.00 __________
6 month m’ship $ 25.00 __________
We invite you to join our committee, as many hands make light work (and it is a great way of getting to know other members and the toy collection!). Would you be interested in joining our committee at some stage? YES NO
I apply for membership of the Echuca Moama Toy Library and agree to comply with its rules and to indemni-fy the Echuca Moama Toy Library, its members and staff against all loss, liability, injury or damage, however caused, arising from borrowing by or through me, of any toys, games or other items.
Date: ____/____/____ Signature: _________________________
Please show some form of identification with current address (e.g. driver’s license) New members: How did you hear about toy library?_________________________________ Availability for roster: (circle all that apply or indicate preferences) Tuesday 10:30 – 11:30 a.m. Saturday 10:30 – 11:30 a.m. No preference
Amount Paid $ ______________________ ID sited: YES/NO License No:______________________
Signature of roster committee member:______________________ Date: _________________
Echuca-Moama Toy Library inc, ABN 43202095720
P.O Box 13 Moama 2731, 34-36 Heygarth Street Echuca, [email protected]
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