New Membership and Payment Form | COTA NT | Voice for Territory Seniors

Membership Services

You can apply or renew individual, joint and Club & Associate memberships on this form 24/7.

If you need assistance, please contact our friendly team in our Darwin Head Office on 08 8941 1004 (Mondays to Fridays, 9am to 3pm except public holidays).

For Corporate membership applications and renewals, click here.

Privacy & Consent: By submitting this form, you agree that COTA NT may collect and handle your personal details to process your request and manage your engagement with us. We manage your data securely via MemberWizard (for member communications) and Stripe (for secure payments). We never sell or share your data with third-party marketers. You can opt out or update your details at any time. For full details on how we handle, store, and secure your information, please view our Privacy Policy or contact us at .

Membership Services

What would you like to do?

Organisation details

Proof of financial situation

Contact Person / Representative's details

Your details

To help us advocate for you more effectively, please indicate:

Second Applicant

To help us advocate for you more effectively, please indicate:

Declaration

Declaration

Payment

Credit card details