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Membership Application Form

ACT Neighbourhood Watch Association Inc.

    Office use only

    Registration No.
    Date of Registration

    * Only one person per form

    ** Mandatory fields. NA if not applicable

    DETAILS OF APPLICANT

    Title**
    First Name**
    Middle Name(s)**
    Family Name**
    Other Names** (Including maiden or former name. Type "NA" if not applicable. )
    Preferred name
    Date of Birth**
    City/ Country of Birth**
    Drivers Licence number**

    CONTACT DETAILS

    CURRENT RESIDENTIAL ADDRESS**

    Street No. and Name
    Suburb
    Postcode
    Time at this Address
    Yrs
    Mths

    PREVIOUS ADDRESS**

    (if at current address less than 12 mths. Type "NA" if not applicable. )

    POSTAL ADDRESS (If different to above)

    Street No. and Name
    Suburb
    Postcode

    PHONE

    Home
    Work
    Mob**

    EMAIL**

    VOLUNTEERING INTERESTS AND ACTIVITIES

    We recognise that many of our members have interests and skills that they may wish to contribute to NHWACT and we appreciate any assistance and time you are able to provide. Please indicate below, any interests and skills you can bring to the organisation and tick any areas in which you would like to be involved. Ticking a box(es) does not commit you - we will be in touch to provide further information and discuss how you would like to be involved.

    INTERESTS AND SKILLS:

    Local Area activities
    Marketing and public relations
    Media (including social media and web publishing)
    Events (including assist as a volunteer at events)
    Information technology
    Corporate Governance and Administration

    Please click here to view the summary of the types of activity which may be included.

    • I declare that the above information is true and correct.
    • I agree to abide by the Constitution of ACT Neighbourhood Watch Assoc Inc, and the policies and regulations of the organisation.
    • I agree to my contact details being provided to the appropriate Management personnel
      within ACT Neighbourhood Watch Association, ACT.
    • I will advise the Membership Secretary should any of my details change.
    • I acknowledge that, as the Neighbourhood Watch Program is a crime prevention program, it is necessary to screen applicants in order to assess their suitability to participate.

    By ticking the two boxes below, I acknowledge that:

    **1. I have read and agree to the terms of membership.
    **2. I consent to ACT Policing conducting a check of its criminal and other records and providing the outcome of that check to the Membership Secretary of ACT Neighbourhood Watch Assoc Inc.
    Date**


    ACT Neighbourhood Watch

    Connect With Us

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    Neighbourhood Watch is a community led safety and awareness program working in partnership with police.

    NHW aims to prevent crime, stop social isolation and increase the safety, security and quality of life for everyone in the community.

    Useful Links

    Contact Info

    Address: 2 Grattan Ct,

                    WANNIASSA,  ACT  2903

    Phone: 0408 395 658
    Email: enquiry@nhwact.org.au

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