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NOMINATION FOR ORDINARY MEMBERSHIP

NSW Wild Harvest Fishers Incorporated
(incorporated under the Associations Incorporation Act 2009)

Personal details

First Name

Last Name

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Email Address *

Contact Number *0 / 10

Region and Shareholder details

As part of Clause 14(1A), please refer region map and advise which region you reside in.

I am a shareholder in the following fishery listed on the NSW DPI Register as:

Name / Business name *

Fishing Business Number *

Nomination and Consent

Nominating Eligible Ordinary MemberThe following person is an ordinary member of the Association and hereby nominates me, as he/she is personally known to me, and supports my membership of the Association.

Date

Fishing Industry NSW Inc

Ordinary Membership Application