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Clubs - Join

Clubs - Join

To join COTA as a Club please complete the form below and click Submit to be taken to the online payment screen.

Club / Association Details

Name of Club / Association:
Address of Premises:
Phone:
Approximate number of members:
Approx. number of members 65+ years:
Month of AGM:
Committee meetings held:
(example: First Tuesday of the month)
Website:
Address(for correspondence):
Postcode:
E-mail Address:
President:
President Phone:
E-mail Address:
Secretary:
Secretary Phone:
NOTE: The Club contact person will be the Secretary unless otherwise specified.
E-mail Address:
Club opening days (for activities)
 
Club Activities (Summary):

Voting Delegate

Please nominate one
NOTE: Voting Delegate receive copies of our magazine
Delegate Name:
Address:
Postcode:
Phone:
E-mail Address:

Privacy Requirements:

The Club / Association / Organisation agrees that information provided may be disclosed to appropriate organisations for COTA SA to meet its legal and association requirements. COTA SA personnel working within the NCC program will also have access to this information.

I agree to the Privacy Requirements.
Name:

COTA SA
16 Hutt Street
Adelaide SA 500

Phone: (08) 8232 0422 Country Callers: 1800 182 324 Fax: (08) 8232 0433

Email: cotasa@cotasa.org.au

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COTA SA acknowledges the Kaurna people of the Adelaide Plains as the traditional custodians of the land our headquarters occupy. We also acknowledge all Aboriginal nations throughout South Australia. We honour Aboriginal peoples’ continuing connection to Country and recognise that their sovereignty was never ceded. We pay our respects to Elders past, present and emerging and extend that respect to all Aboriginal people.

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