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Member Registration Form

Section A: MEMBERSHIP Fees.
(Please tick the relevant box.)
Single Membership – AUD 20.00
Joint Membership – AUD 25.00
( Two members residing at the same address. )
Postage Premium
– AUD 25.00 ( additional ) 
Annual subscription: Subscription is for a financial year July 1 to June 30 the following year. New memberships commencing after January 1 of any year will be financial until June 30 of the following year.
Postage Premium: The postage premium is an additional fee for those applicants without internet access to help cover the printing and posting costs associated with the distribution of essential aspects of Country Network.
Section B: Applicant details.
 Declaration: I hereby apply for membership of Country Network. I declare that I am over the age of 18 and will abide by the rules and the spirit of Country Network. 
Section B2: Second applicant of Joint Membership. 
( if applicable )
 Declaration: I hereby apply for membership of Country Network. I declare that I am over the age of 18 and will abide by the rules and the spirit of Country Network. 
Section C: Hosting Arrangements
Country Network’s aim to promote and encourage social contact between members has created a strong tradition of hosting fellow members.  Your decision to choose who and when you host will always be respected.
 Host 
 Guide 
 Single 
 Twin 
 Double 
 Share 
( Hosts must ensure guests have a clear understanding of what bedding is available prior to 
any visit, especially if the only bed available is to share that of the host. )
 Yes 
 No 
 Outside 
( Hosting arrangements are strongly guided by our protocols of which all members are to comply. )
You can amend your profile at any time in the “members only” section of the Country Network website, or by contacting the Registrar with any required amendments.
SECTION D: Confirmation of Identity.
(you must satisfy either of the following requirements):
 I/We are known to Country Network member 
 I/We have attached a copy of my/our photo identification (drivers license passport etc.) 
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Section E: PAYMENT
(Please tick the relevant box.)
Direct Credit or Self Deposited funds to bank account
BSB 015 881 Account No 477 937 562
Credit Card Online (MasterCard & Visa only)






  •  yes 
  •  no 
 Email 
 Home Phone 
 Mobile 
 Picture 
 Birthday 
 Interests 
Direct Credit or Self Deposited funds to bank account
(BSB 015 881 Account No 477 937 562)

OR

Credit Card
(please complete the following details)
Any questions or concerns, please contact The Registrar on 0419 551 245 or registrar@countrynetwork.com.au
Once approved, you will be emailed a ‘Welcome Letter’ with your log-in details, along with additional information enabling you to get the most from your membership.
We thank you for your registering and look forward to welcoming you soon to the Country Network family