PCAG Membership Application form

Your Name (required)

Business Name(if applicable)

Your Email (required)

Mobile Number

Estate Name in Point Cook

Please choose your priority areas from the list below.
SafetyPublic TransportCommunityYouthOthers

What other Point Cook issues would you like to address?

Please confirm the membership type you would like to apply?
Individual Membership($20)Student Membership($10)Corporate Membership($50)

Please confirm the preferred payment method for membership fee?
CashBank Deposit (Bank Deposit – Point Cook Action Group Inc Bendigo Bank - BSB 633 000 Acc 153 095 666)

Additional Notes regarding payment (e.g. Transaction id for payment made/ Date of payment made)

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