Membership

APPLICANT INFORMATION
Name:
Email address:
Phone:
Current Address:
ORGANIZATION INFORMATION
Organization Name:
Organization Address:
Organization Phone:
Email address:
Fax:
City :
State:
ZIP Code:
PRESIDENT
Name:
Email address:
Phone:
SECRETARY
Name:
Email address:
Phone:

I authorize the verification of the information provided on this form. I have received a copy of this application. I will arrange to pay the membership fees $100 per annum at the earliest.

Account Name: Federation of Indian Origin Multi-Faith OrganisationInc
BSB: 063-182
Account number: 1122 2578


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