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APPLICATION FOR MEMBERSHIP OF ASSOCIATION

Pokolbin & District Vignerons Association Incorporated.

(incorporated under the Associations Act 1984, No. INC9877186)

I, ________________________________________________________________________________________________________

(full name of applicant / corporation)

of ________________________________________________________________________________________________________

(address)

___________________________________________________________________________________________________________

(occupation / corporation)

hereby apply to become a voting member / associate member of the abovementioned association. In the event of my/our admission as a member, I/we agree to be bound by the rules of the association for the time being in force.

I am a member of the following:-      HVVA  yes / no        HWCPID  yes / no      HVWC Tourism   yes / no 

________________________________________________               ________________________________________________

                         Signature of applicant                                                                                     Date

I, ___________________________________________________________ a member of the association, nominate the applicant, who is personally known to me, for membership of the association.

________________________________________________                      ________________________________________________

                         Signature of proposer                                                                                     Date

I, ___________________________________________________________ a member of the association, second the nomination of the applicant, who is personally known to me, for membership of the association.

_______________________________________               _____________________________________

                         Signature of seconder                                                                                      Date

Additional information in respect of application as a MEMBER:

Name & Address of wine grape vineyard / winery  ____________________________________________

__________________________________________________________________________________________________________

Area of vineyard ______ hectares.     Name of related Corporation (if any) _____________________________

Additional information in respect of application as an ASSOCIATE MEMBER:

Name & Address of business  ____________________________________________________________________________

__________________________________________________________________________________________________________

Nature of business ______________________.      Name of related Corporation (if any) ______________________

SCALE OF FEES

Joining Fee:-        $25.00 all classes of membership

Annual Fee:-         $75.00 Voting Member

Annual Fee:-         $40.00 Associate Member

Return application to:  Pokolbin & District Vignerons Assoc. Inc.   PO Box 180, Cessnock, NSW 2325

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