Please print this page, tick the appropriate boxes and post with your cheque to
COSHG, PO Box 251 Brunswick East 3057

I agree with COSHG Aims or Our group has discussed COSHG aims and is in agreement with them

Enclosed is
$15 (for self help groups or individuals)
$5 concession
$25 for small organisations that actively support self help groups
$50 for large organisations and service providers

There is No GST payable.

Discounts on COSHG workshops may apply to membership

There are two kinds of membership. Please tick the membership you are applying for.

Full membership for self help groups or individuals actively supporting COSHG.

(Groups should appoint one person as their nominated representative)

Associate membership (non-voting) for people or organisations that support the aims and objectives of COSHG

If you are applying for full membership, please indicate your interests:

attend AGM and/or other meetings
visit or help at COSHG office
attend or help with workshops, events or info stalls
respond to issues or questions raised in news sheets
send to COSHG information that could be useful to other groups
other .............................................................................................

Applications for membership are reviewed by the management collective.

Name of group/ person and address:

............................................................................................................

............................................................................................................

............................................................................................................

Phone: .................................................. E-mail: ....................................

Please send Collective Notes by e-mail mail

Our membership year is from July to June.

Signature: ............................................. Date: .....................................

Last updated 19 July 2007