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First Name*

Surname*

Email*

Phone number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is the name of the Traditional Owner land on which you live?*

Tell us why you would like to become a member of GWRN?*

Are you interested in volunteering for GWRN? If so in what way?*

What skills can you share with GWRN?*

What amount of time would you be able to commit to volunteering for GWRN?*

More than a day a week
half a day to a day a week
1-2 hours a week
less than an hour a week

What does reconciliation mean to you?*

Please provide any links of supporting material?

Your age…*

What is your primary association with Gariwerd and the Wimmera region?

As per our rules of incorporation, basic members details are entered onto the GWRN membership register. Members of GWRN can make a request that personal details be restricted from the register if there are special circumstances.

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Reason for Privacy*

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Association Rules*

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Become a Member

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