Name: Mansfield Producers Twilight Market
Start: 2019-10-04T17:00:00+10:00
End: 2019-10-04T21:00:00+10:00
Location: Mansfield Botanic Park

Membership Application Form

Before you complete this form, and if you are able to at this stage, please prepare your content for your website listing as follows:

Full members - text up to 250 words
Associate members - text up to 150 words
The images you wish to use for the "All Mansfield Producers" page as well as your individual producer page. Up to 6 images for full members and 1 image for associate members.

(You can submit this content later if you cannot at this stage).

* = required field.

Step 1 of 3

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Business Name*
ABN/ACN
Primary Contact Name*
First Name Last Name
Phone Number*
Email Address*
Website
Postal Address*
Address Line 1 Address Line 2 City State Post Code
Street Address
If different to your postal address, otherwise leave blank.

Address Line 1 Address Line 2 City State Post Code
Producer Category*
Which of the following product/service categories best fits what you do?
Membership Category Required*

Full Member Website Content
If you are able to do so now, please provide a description of your business and any key points you would like included on our web page. Maximum 250 words.
Photos
If you are able to do so now, please upload your Photos here. Maximum: 6 photos, size less than 1MB.
Drop files here or
Associate Member Website Content
If you are able to do so now, please provide a description of your business and any key points you would like included on our web page. Maximum 150 words.
Photos
If you are able to do so now, please upload your photo here. Maximum: 1 photo, size less than 1MB.
Additional Information
Please add any additional information, e.g. about your Mansfield Producers website entry, here.
Signature*
On behalf of the above organisation, I hereby apply for membership of Mansfield Producers Inc. I have read and understood the constitution of Mansfield Producers Inc, and upon approval as a member, agree to be bound by those terms. Membership is not valid until Mansfield Producers Inc has received and accepted this application. I declare the above information to be true.
Payment Option*
Membership Fee*
Price: $ 0.00

You have selected {Membership Category Required:17}.

Based on this category, your membership fee is {Membership Fee (Price):30.2}.

Please submit your payment fee as a direct deposit into our bank account.

Bank account details:
Bendigo Bank
Mansfield Producers Inc
BSB: 633108
Account: 161182886

Your membership will be confirmed once payment is received.
Phone
This field is for validation purposes and should be left unchanged.

Membership Application

Membership Application Form

Step 1 of 3

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Mansfield Producers Twilight Market