APPLICATION FOR MEMBERSHIP
I / We wish to become member/s of FRIENDS OF HERRING ISLAND INC. (A0028229X)

Full Membership
[ ]  Entrance Fee - 	$25.00
[ ]  Annual Fee   - 	$ 2.00         
          or                                                    
Associate membership 
[ ]  Annual Fee  	$ 3.00
                             

GIVEN  NAME      :  __________________                         
FAMILY NAME      :  __________________                         
Address          :  _________________________                  
                    _________________________                  
                    _________________________                  

Telephone  :(H)     ______________                             

Telephone  :(W)     ______________                             

Email      :        _________________________

Occupation       :  _________________________                  

Special Interests: 	
 _______________________________________________                  
 _______________________________________________
 _______________________________________________
                          

Please print and complete this form, then send it to:

     THE TREASURER,
     FRIENDS OF HERRING ISLAND INC.
     10 GRACE ST,
     MONT ALBERT VIC 3127