Moana Pasifika Association Inc : All Correspondence P 0 Box 276 Rockingham City Western Australia 6168 Tel 0404 585 008 ABN: 45166521280
Includes the " Spirit of the Pacific " radio programme
Membership Application / Renewal
I wish to ( select one) a) become a member of b) renew my membership to Moana Pasifika Inc.
Name/ Organisation: __________________________________________________
Address: ___________________________________________________
Post Code: ____________________________________________________
Telephone: ____________________________________________________
Fax: ____________________________________________________
Email: ____________________________________________________
Mobile Phone: ____________________________________________________
I/We agree to support the aims of Moana Pasifika Inc
Signed Date ____________________________________________________
Membership Fees A) Individual Full $10
B) Family (includes school age children) $20
C) Organisation $20
D) Donation $
Total amount enclosed $____________________
Cheques should be made payable to :
Moana Pasifika Assoc. Inc
P 0 Box 276 Rockingham City
WA 6168
To Join Click Link Below for an Application form
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