Name

Email Address

Address

Address in Currarong (if not a permanent resident)

Phone

Mobile

Do you live permanently in Currarong? Do you live permanently in Currarong?YesNo

If you don’t live permanently in Currarong how often to visit?

Current occupation: Please list previous occupation if retired

Other skills or interests relevant to the community

What are the issues that most interest you in Currarong?

Volunteer Volunteer Arts & events Fundraising (e.g. Bingo) Hall maintenance Funding proposals Committees Other (please list):

Other

Declaration Declaration Our purpose, as detailed in our constitution is: The Association will act in the interests of its members and the wider Currarong community by: a) liaising with the Shoalhaven City Council, NSW Government, Australian Government and all other relevant business and community bodies to secure support, funding and public works b) providing, receiving and distributing relevant information and feedback concerning Currarong and the surrounding and wider area c) promoting community events and activities d) using its assets in accordance with these objects. Our Association depends on volunteers to undertake these activities. In submitting this form to the CCA Committee I agree to abide by the Associations rules as detailed in the Constitution