A1
Form 701

Lodged By:
Name:
Address:
E-mail: 
Telephone (BH):

APPLICATION TO INCORPORATE AN ASSOCIATION

		 PRIVACY COLLECTION STATEMENT (PRIVACY ACT 1988 (C’WLTH)) OVERLEAF 

1.  NAME AND RESIDENTIAL ADDRESS OF APPLICANT	ASSOCIATION NUMBER
(Person authorised under S.16 to apply for incorporation of the association – must reside in ACT)	(office use only - assigned
     		upon incorporation)	
     		A     	

2.  NAME OF ASSOCIATION  	3.  TOTAL MEMBERS
     			

4.  ADDRESS AND HOURS OF REGISTERED OFFICE OF ASSOCIATION (optional)	
     	From:	      :      	
     	To:	      :      	

An association is not required to have a registered office.  If a registered office is established, it must be located at a physical address in the ACT and be open for at least 3 consecutive hours between 9.00 am and 5.00 pm Monday to Friday (excluding public holidays). 

5.  NAME AND RESIDENTIAL ADDRESS OF INAUGURAL PUBLIC OFFICER (must be 18 years or older and reside in ACT)
     	

6.  PREFERRED POSTAL ADDRESS OF ASSOCIATION 
     	

7. NAME AND RESIDENTIAL ADDRESS OF INAUGURAL COMMITTEE (if insufficient space, attach list with remaining information) 
Full Name	Residential Address (must be valid for Australia Post mail delivery)	Position Held	
     	     	     	
     	     	     	
     	     	     	
     	     	     	
     	     	     	
     	     	     	
     	     	     	
     	     	     	
     	     	     	

8. OBJECTS AND PURPOSES (AIMS AND OBJECTIVES) OF ASSOCIATION (if insufficient space, attach annexure) 
     	
     	
     	
     	

9.  INAUGURAL RULES OF ASSOCIATION (select only one)
If the association has adopted the Model Rules from the Associations Incorporation Regulation 1991, place an 'X' here: 		
The Model Rules cannot be altered. Under the Model Rules, the committee has 7 positions, being President, Vice-President, Secretary, Treasurer and three Ordinary Committee Member positions.  It is not necessary to attach a copy of the Model Rules.	
If the association has drawn up and adopted its own set of rules in place of adopting the Model Rules, place an 'X' here: 		
A full copy of the rules must be attached to this form, together with a completed Rules Reference Schedule.  The inaugural committee is responsible for ensuring that the rules are complete and comply with the Associations Incorporation Act 1991.	

10.  DEEDS AND TRUSTS
Do any legal, financial or property deeds or trusts exist which affect this association?  		If yes, a certified copy of each legal, financial or property deed or trust document which affects this association must be attached.	

11.  STATEMENT BY APPLICANT 
I confirm that all of the particulars shown on this form are true and correct, that I have been authorised under Section 16 of the Act to apply for incorporation of this association, and that I have read the "Privacy Statement" and "Important Information" shown below.	
							
	Signature		Name		Date		

PRIVACY STATEMENT

Section 9 of the Associations Incorporations Act 1991 provides for the Registrar-General to collect the information for the purpose of establishing and maintaining the register of incorporated associations.  The register is available for search pursuant to Section 11 of the Act, to any person upon payment of a fee.  The register is also made available to a range of government agencies for law enforcement, administrative and statistical purposes.

IMPORTANT INFORMATION

The incorporation of an association creates a legal entity, under the management of the committee members.  The committee members are held accountable for ensuring that the association operates in compliance with applicable laws, including the Associations Incorporation Act 1991 (the Act) and the Associations Incorporation Regulation 1991  (the Regulation). The public officer is responsible for acting as a point of contact between the association and the community, and is expected to be able to represent the association in dealings with this office.  The Act prohibits any person from serving as a committee member or the public officer if he/she is insolvent or bankrupt, without leave from the ACT Supreme Court under S.63 of the Act.  A search should be conducted of the records held by the Insolvency and Trustee Service Australia (ITSA) before accepting the nomination of a person as a committee member.  For more information or to conduct a search, visit the ITSA website at www.itsa.gov.au. Further information on the obligations of incorporated associations can be found in the Associations Kit available from the Registrar-General's Office, and on-line at www.rgo.act.gov.au. 

LOCATION
255 Canberra Avenue
Fyshwick   ACT   2609

OFFICE HOURS
9.00am to 4.30pm Monday to Friday
(excluding public holidays)

CONTACT NUMBERS
Phone	(02) 62070435 or 
	(02) 62070474  
Fax 	(02) 62070487

POSTAL ADDRESS
PO Box 225
CIVIC SQUARE   ACT   2608