New Member Application Form

Your Program Name
Community Group
e.g. Mandarin Language, Italian Community, Multicultural Youth, etc.
Program Language(s)
Program Type
- Single Language
- Multicutural
Station (call sign)
Your Group: (please provide contact details of your program or group members, not the station.)
Name
First Last
Role
Postal Address
Street Address Address Line 2 City ZIP / Postal Code Country
Phone
Email
Details of additional people broadcasting on your program
First Name Surname Role Email

The role in this question could be Researcher (R), Producer (Pro), Reporter (Rep), Journalist (J), Presenter (P) or Panel Operator (PO). Click the + sign to add more people.

First Name	Surname	Role	Email