Membership

Welcome to HPCH Portal

HAMPTON PARK COMMUNITY HOUSE

Annual Application for Membership

ABN: 91 334 724 925

16-20 Stuart Ave, Hampton Park VIC 3976

Phone: (03) 8768 8342

Name*

First Name

Last Name

Date of Birth*

Membership Start Date

Address*

Address Line 1

Address Line 2

City

State

Postcode

Contact Number*

Email*

Are you already a member and renewing your membership?

Yes - I am a current member of Hampton Park Care Group. No - I would you like to become a member of the Hampton Park Care Group.

Where would you like to assist HPCH?*

Volunteering Children's Services Family Services Community Services Projects Programs Events Board Member Something else

Would you like to pay your membership by a credit card?

Yes - I wish to proceed with online payment for $2 No - I will pay cash or will EFT

Membership fee A$

Credit Card*

EFT Details

Please provide details if you wish to.

Member Nomination Name 1

First Name

Last Name

Member Nomination Name 2

First Name

Last Name

Please sign here*

In the event of my admission as a member, I agree to be bound by the rules of the Hampton Park Care Group Inc. for the time being as serving member.

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