Membership Application – Queensland Nepalese Cultural Centre Inc.

one) Applicant $200):

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

Membership Type

Please select membership type below.

Membership type

Individual Life Member ($1000)
Family Life Member ($1500)

Applicant Names

Please provide the full names of all applicants.

Applicant 1 *

Name of the main applicant

Payment Option

Please choose your payment method and provide the necessary details.

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.

Donation amount ($)

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. Please enter the amount here if you would like to make any donation.

Pledge date

I/we pledge to deposit the committed donation amount by this date. Please enter the date in DD/MM/YYYY format (for example 12/01/2026 for January 12, 2026)

Please click the button below for bank details.

Contact Details

Kindly provide your contact details below.

Address *

Street address

Suburb / Town

State / Territory

Postcode

Phone number *

Please enter your phone number here.

Email Address *

Confirm Email

Please provide a valid email address. This will be your primary contact method for future communications.

Facebook ID

Consent

Please give your consent to the use of your name photograph and other details.

I/We consent to:

Publishing my/our name(s) in QNCC membership list in the media.
Sharing my/our name(s) with other QNCC/community members during a community event.
Using my/our name(s) and photo(s) in media for promotional purposes.
Adding my/our details to mailing list & messenger group for QNCC related information.

Please tick all that apply.

Signature *

Please enter your full name to confirm you’ve provided accurate details in this form.

Date *

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.