PLonQ Membership If you are unable to complete the following online Membership Application Form, please download, complete and sign the PLonQ Membership.pdf and return to PO BOX 320 Queenscliff Victoria. Thank you for your interest in joining PLonQ. We will contact you shortly regarding your application.I wish to be considered for Membership of PLonQ.*In doing so I confirm that I: Support PlonQ’s Mission Statement; purpose; commitment and expectations (see below) Agree to comply with the PlonQ rules (as per the Model Rules for an Incorporated Association, Associations Incorporated Reform Regulation 2012) Contact detailsName* First Last Email Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Member DetailsYou are requesting to join PLonQ as a:* Business owner/trader A member of the local community Other (specify below) Business Owner/trader additional info required (ABN, Business name, address & phone number):Specify member typeOptions: regular member (contribute feedback for meetings without attendance), committee member (attend PLonQ meetings & participate in ideas & planning). Membership fees (funding PLonQ administrative costs):* $50 Resident $100 Business owners Paid to:Account Name: PLONQ INCORPORATED BSB: 633000 Account No: 174468439 Please add any additional information of relevance to your application hereConsentPRIVACY STATEMENT All information you provide will only be used for PLonQ membership-related purposes and activities and we will not share the information you have provided in an identifiable form with any third party. MISSION STATEMENT PLonQ Inc is a non-profit community organisation which has been established to instigate and promote more cultural activity and community cohesiveness in the Borough. PURPOSE PLonQ’s purpose is to be: — Active in seeking ways to advance the quality of life for those who live and frequent the Borough of Queenscliffe (BOQ). — Active in finding ways to offer a unique experience for those who visit, including: identifying and progressing ideas about connecting the two towns more effectively through local transport and an all-inclusive attitude. — Focused on brightening the Borough facade and neatening of our thoroughfares. — Thoughtful in ideas for implementing signage and branding that boasts place pride and connections with communities past and present. — Working within the BOQ’s offering and traffic capacity to respect the local environment. — Supporting local businesses by promoting resources and inventing small getaway experiences for visitors. — Remaining open and enthusiastic toward locals wanting to join PLonQ’s projects and aligning with the BOQ so that each others’ efforts are enhanced. PLonQ’s commitment is to: — Pride of place. — Be enthusiastic about moving forward and working towards achieving its goals. — Remain encouraging of positive feedback and suggestions from members. PlonQ Members: — Enjoy instigating more cultural activity. — Possess the drive and energy to make things happen. — Are open to new ideas and fresh approaches. — Have cultural event management experience (or a willingness to support these activities). — Are able to stay focused on the Group’s agenda. — Are professional and have a positive approach. — Are forward looking and solution focused.Date* MM slash DD slash YYYY Consent* I agree to the privacy & mission statementsPlease select and submit or print pdf and return via post to: PO BOX 320 Queenscliff 3225.