Name *

First Name

Last Name

Address *

Address 1

Address 2

City

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Country

Phone *

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Agreement *

I/we are passionate and interested in supporting the constructive social and economic development of Coober Pedy, working collaboratively together. I/we support the objects (aims) of Coober Pedy Together, the Coober Pedy Together way of working (found in the Coober Pedy Plan 2024-28), and agree to abide by the rules set out in the Coober Pedy Together constitution (available on the Coober Pedy Together website).

Acknowledgement of Process

I/we acknowledge that a nomination for membership of Coober Pedy Together, must be supported by an existing Member of the Association, seconded by another Member, with final approval granted by the Facilitation Group at its next meeting. I/we acknowledge that completing this form does not constitute membership, and that the facilitation group will be in touch once the membership application process is complete.