Name of Organisation (required)

Address of Organisation:
Address line 1:

City

State/Province/Region:

ZIP/Postal Code:

ABN

Phone number

Email

Hereby apply for membership of the National Aboriginal & Torres Strait Islander Women’s Alliance (Indigenous Corporation)

On behalf of the organisation I declare that the organisation is eligible for membership under Rule
5.2 (see below) and that the organisation is willing to be bound by the rules of the corporation.

The organisation nominates the following person to be their representative in relation to NATSIWA
business:

Name

Phone

Email

Website

Date