Life Membership Application – Queensland Nepalese Cultural Centre Inc.

Please download the form below, complete the details and submit it with the membership fee payment. The banking details for the payment are provided in the form.

I/We would like to apply to be a member of Queensland Nepalese Cultural Centre (QNCC).

Membership Type

Please select membership type below:
Individual Life Member (Fee $1,000)Family Life Member (Fee $1,500)

Applicant Names

Applicant 1 (required)

Applicant 2 (for Family Life Membership)

Payment Option

Payment Option (please select one)
I/We have made/will be making full payment.I/We will be making an instalment payment. I/We will pay the first instalment immediately and the remainder in instalments within one year of this application. I/We understand that membership will only be granted after the full fee is paid. In the event of a failure to make full payment within one year, the payment will be recorded as a donation and this application will be cancelled.

If paying by instalment, enter initial payment amount (minimum $200):

$

In addition to the membership fee, QNCC is also collecting donation from the community members. Although this is vital for the fast tracking of the project, it is not compulsory and is entirely up to the applicant(s) to decide the donation amount.

In addition to the membership fee above, I/We would also like to donate to QNCC (optional).

Enter donation amount:

$

I/We pledge to deposit the membership fee/donation amount by:

Please click the button below for bank details.

Consent

I/We consent to (please tick all that apply):
Publishing my/our name(s) in QNCC membership list in the mediaSharing my/our name(s) with other QNCC/community members during a community eventUsing my/our name(s) and photo(s) in media for promotional purposesAdding my/our details to mailing list & messenger group for QNCC related information

Contact Details

Address (required)

Phone Number (required)

Email Address (required)

Facebook ID

Signature

By typing your name below, you certify that you wish to submit this application for QNCC Life Membership.

Date of Application

Declaration

By submitting this form, I/we confirm that the information provided is accurate and agree to the QNCC membership terms and conditions, including the payment and instalment policy.