ACT Membership Form

Title (required)

First name (required)

Last name (required)

Email address (required)

Membership type (required)

Are you applying for membership on behalf of a community group, school or business? (required)

NoYes

If yes, please state which community group, school or business

Where do you/your group live? (required)

Please state your location (not your full address)

Do you agree to be contacted by ACT? We will only contact you with regard to ACT news and events and will not pass your details on to any third parties. (required)

YesNo

Please indicate your age group (optional)

Thank you for supporting ACT.

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