8/9/2019 CBN Membership Form1

1/1

Membership/DonationSchemeCambodianBroadcastingNetworkIncorporation YES,Iwouldliketomakeadonation: $20 $30 $50 Other:________YES,Iwouldliketobeamemberoftheorganisationandenclosedismyannualmembershipfee.PersonalDetails:GivenName:_______________________________FamilyName:________________________________HomeAddress:__________________________________________________________________________State:_________________Postcode:_________Office/HomeNumber:___________________________MobileNumber:_______________________Email:_____________________________________________Howwouldyouclassifyyourself?(pleasetickbox):

Student ProfessionalFulltime Parttime Fulltime Casual Jobseeker

Selfemployed Others:______________University/TAFE:____________________________________

Course:____________________________________________

DateComplete:_____/_____/_____Employer Name: _________________________________

Occupation:____________________________________

SupportingDocuments:

Please

include

any

info

which

will

support

your

application,

E.g

Industry

memberships,

Camera

club

memberships,

NGO

Certificate

or

Certificate

ofBusinessRegistration.

AtCBN,thefutureisbright,wewouldliketointroducenewmembershipleveleffectivefromJune2010.CBNMembershipScheme(MS)

FeedbackfromViewers:ItsnicetoseeathrivingKhmercommunityinAustralia.Thanksforsharing."..."GreatChannel."..."Extremelyintriguing.:D"ThelaunchofCBNseemedverysuccessful.Itwasagoodrangeofattendance.MycongratulationstotheCBNteamandyourpassioninthisfield."TermsandConditionsofMembership:ThepersonnameonthisapplicationwishestobeamemberoftheCBNMembershipScheme,entitlingthemembertothevariousbenefitsunderthatScheme.Uponacceptanceofmembership,thememberagrees:1.Toadviseofanychangesofdetailsincludedinthemembership

application,includingaddress,phonenumbers,occupation,statusasafulltimeworkingprofessional,registrationupdateofNGOandBusinessRegistraionorany

changestothemembersregistereddetails.2.CBNIncmaykeepyouinformedaboutotherproducts,servicesandofferswhichmaybeofinteresttoyou.3.Ifyoudonot

wishthesecommunicationstomadetoyoupleasenotifyCBNSponsorshipandGrantsCommitteeviaCambodianBroadcasting@Gmail.com.ThatCBNMembershipis

validonlywhilethememberremainseligibleformembership.4.ThatCBNIncmay,atanytime,makechangestothebenefitsandthetermsandconditionsofCBN

MembershipSchemeandthatCBNIncwilltakereasonablestepstonotifycurrentmemberofanychanges.5.Theapproval,rejectionorcancellationofCBN

MembershipSchemeisatthesolediscretionofCBNInc.EachCBNmemberisboundbythetermsandconditions.Ihavereadandagreetothefulltermsandconditions

asdetailedintheCBNMembershipSchemedocumentation,andcanconfirmthatalldetailsarecorrect.

FullName:_________________________________________________________________ApplicantsSignature:________________________________________________________Date:

_________

/_________

/__________

HowtopayyourMembershipFee?1.BankDetailsforElectronicTransfer:AustraliaandNewZealandBankingGroupLimited(ANZ)

Accountname:CambodianBroadcastingNetworkInc.BSB:013 141Account:904 263858

2.PaymentbyChequecanbemadeto:CambodianBroadcastingNetworkInc.PleasesenttoTheSecretaryCBN:POBOX107,Nunawading,Victoria,3131,AUSTRALIA

3.CashinhandOFFICEUSEONLY: IND NGO PRO

DATEISSUED:_______/_______/_______MEMBERNUMBER:______________________________________CBNCOMMITTEENAME:___________________________________SIGNED:__________________________

Individual(Supporter)$100pa NGO(Nonprofit)$500pa Business(Profitcompany)$1000pa"BasicPackage"Benefits: "BasicPackage"Plus+ "BasicPackage"Plus+

1.AccesstoCBNandMyCambodiaTV

websites.

2.10%offtickettoourupcoming

events.

3.FREENewsletter.

1.2FREEticketstoourupcoming

events.

2.Partnershiplistingonbothofour

websites.

3.AdvertisementBanneronbothofour

websites.

1.5FREEticketstoourupcomingevents.

2.Partnershiplistingonbothofour

website.

3.AdvertisementBanneronbothofour

website.

4.

10%

Discount

on

TV

Sponsorship

deal.