CASTLEMAINE PAY THE RENT SCHEME – Castlemaine Pay the Rent

Supporter Application Form

I/we want to be part of the Castlemaine PAY THE RENT SCHEME
Name/s*
Address
Street Address City State Post Code
Email*
Phone
Consent
Please mark the relevant boxes to indicate your acceptance or selection.
- I/we understand my/our name/s and rent payment amounts will be kept confidential and that only the Castlemaine PTR admin will have access to this information. Castlemaine PTR admin, will not share your personal information with other individuals or groups/or businesses.
- I/we understand that rent money I/we pay, is not a donation. It is a restorative justice payment
- I/we agree to notify the Castlemaine PTR group: castlemaineptr@gmail.com if I/we want to alter my/our rent payments or if my/our contact details change.
- I/we commit to being open to learning more about; on going colonisation, structural racism & cultural bias & white privilege. And to self reflect on how you benefit from living on stolen Aboriginal Land. Note: It is up to other Australians to educate themselves and not expect Aboriginal and Torres Strait Islander peoples to do the work for them.
- Castlemaine PTR admin may occasionally provide an update email on the Scheme. Would you like to receive them?
I/we plan to contribute:*
Frequency of payment:*
- weekly
- monthly
- yearly
- one-off payment
Start Date*
DD slash MM slash YYYY
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

If you have any further queries, or would like us to post you a blank form, please email your postal details to: castlemaineptr@gmail.com