Energy Action Group Inc

Membership Application

TAX INVOICE

ABN 14025 686 203

I wish to become a member/renew my membership of the Energy Action Group Inc, and support it’s purposes and agree to conform to its rules.

NAME....................................................……………....

ORGANISATION (if applicable) ..................................................................…………….

ADDRESS.............................................................................................................………………………………

.............................……………..POSTCODE................

TEL..................……........FAX.....……….....................

EMAIL.....................................………...……...............

Skills & other involvement that you may be able to offer

..................................................................................................................................................................................................................................................................

Attach cash/cheque for $..................…………...............

SIGNED...........................................Date……………

RATES

$22.00 (inc GST) per year waged

$5.50 (inc GST) per year unwaged

$55.00 (inc GST) organisation

Make cheques payable to the Energy Action Group Inc

donations welcome

return to: EAG

PO Box 136

North Melbourne 3051

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