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