Membership Application

IMPORTANT NOTES:

contact Graham Park with any queries 0418 700 320
2 levels of membership available
you must have reached executive level to apply to become a member at either level
your application (including 2 character referees) will be reviewed by the centre directors before acceptance
memberships are for a minimum 6 month period
a refundable key deposit (1 months membership fee) is payable (returned to you or applied to membership fees upon cancellation of membership, but forfeited if cancellation is less than 6 months)

Please complete the form below to apply for membership. All fields are required unless specified.

Name:
Postal address:
Telephone:
Mobile:
Email:
Password:
Password confirmation:
Membership Type: (Automatically billed monthly)	Executive Key Holder ($85.00 per month) Executive Director ($250.00 per month)
Membership details
Distributor ID #
Current Executive Pin Level
Upline Executives' Name
Upline Executives' Telephone
Upline Blue Diamonds name: (not mandatory)
I have read and agree with Membership Terms and Conditions	Yes No
Referrees Can be your upline or other NSE Distributor or non NSE Distributor
Referree 1
Name:
Telephone:
Referree 2
Name:
Telephone: