Apply to be a member

Membership Application Form

ACT Neighbourhood Watch Association Inc.

    Office use only

    Registration No.
    Date of Registration

    * Only one person per form

    DETAILS OF APPLICANT

    Title
    First Name
    Middle Name(s)
    Family Name
    Other Names (Including maiden or former name)
    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)

    POSTAL ADDRESS (If different to above)

    Street No. and Name
    Suburb
    Postcode

    PHONE

    Home
    Work
    Mob

    EMAIL

    • 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


    Why Should I Join NHW?
    ACT Neighbourhood Watch

    Connect With Us

    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.

    Contact Info

    Address: Havelock House, 85 Northbourne
    Ave, Turner ACT 2612