Application for Community Membership

To initiate a Community Membership application this form must be completed by an office bearer of the applicant regional arts organisation. Regional arts organisations must be a Community Member (formerly known as Affiliate Member) of Regional Arts NSW in order to participate in group insurance.

Organisation Name

ABN or Incorporation Registration Number

Main Activity of Organisation

Contact Name

Position in Organisation

Postal Address

Principle Place of Business

Telephone Number

Mobile No.

We are interested in the following types of insurance: We are interested in the following types of insurance: Broadform Liability (Public Licability) Insurance Voluntary Workers Personal Accident & Injury Insurance

What are the main activities of your volunteers within your organisation?

9 + 1 =

Application for Community Membership

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