Register your Group

Community Group membership application to join the Lock The Gate Alliance.

This form is for Community Groups. If you want to register as an individual full "ordinary member", please use this form.

You can also print the form linked at the bottom of this page and send with a cheque payment.

A fee of $10 is per member group will be required for membership through to midnight 30 June 2012. Payment options (Paypal, EFT or Cheque) will follow on the next screen.

Application Form

Organisation or Group Name (required)

Primary Delegate - First Name (required)

Primary Delegate - Surname (required)

Primary Delegate - Email (required - one only)

Primary Delegate - Phone (required)

Alternate Delegate - First Name (leave blank if not needed)

Alternate Delegate - Surname (leave blank if not needed)

Alternate Delegate - Email (leave blank if not needed)

Alternate Delegate - Phone (leave blank if not needed)

Organisation Postal Address (required)

City/Town (required)

State (required)

Postcode (required)

Website (leave blank if not needed)

Facebook Page or Group (leave blank if not needed)

Message - anything else we should know?

Note: By submitting this form and applying to become a Group Member, you are agreeing to be bound by the rules and guidelines that are laid out in the Constitution (link below).

Privacy Statement: Email address and other information collected on this form is for use only by the Lock the Gate Alliance for the purpose of administering the Alliance. No information is shared with any other group or organisation.

Related Documents

Community Group Membership Application Form (Opens in new window) (91kb pdf file)
Print and fill in this form and return with a cheque payment to the address defined
Lock the Gate Alliance Inc Constitution (Opens in new window) (341kb pdf file)
Please read the Lock the Gate Alliance Incorporated Constitution carefully before you make a commitment to sign up officially as a member. In becoming an official member, you are agreeing to be bound by the rules and guidelines that are laid out in this document.

Documents marked with may only be available in PDF format. If you don't have Adobe Acrobat (or the reader), a FREE reader is available from Adobe.

Comments from Lock the Gate Alliance members and supporters

I support the cause and I am appalled at the government inaction and support on this issue.

Pritpal - St Andrews, New South Wales

Lock the Gate Alliance

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