Bend of Islands Conservation Association Inc A11100A


Membership Renewal or Application

Subscription rates for 2004 are as follows.

Single membership $20
Family membership $30
Concession membership $10

Please find enclosed $              being for new/renewed membership of BICA inc.

Name:	__________________________________________________

Address:	__________________________________________________

	__________________________________________________


Phone:	__________________________________________________


Mail this form to:
 
The Treasurer
BICA inc
C/- PO, Kangaroo  Ground
Vic, 3097