Join—Julie Humphris referral page

New Membership Application (Julie)

Application as a new member to THE Rural Women Co-operative

First Name(Required)

Surname(Required)

Email(Required)

Phone(Required)

Street Address(Required)

Town/City/Suburb(Required)

State(Required)

Gender(Required)

Month of Birth(Required)

Do you identify as a woman living in a rural, remote or regional area? OR Do you support the advancement of rural women and girls?(Required)

Yes

Are you of Aboriginal or Torres Strait Islander Origin?(Required)

Yes

Which language do you mainly speak at home?(Required)

English

Other