Friends of Edithvale-Seaford Wetlands Inc.

A0017388A Victoria

PO Box 2031 EDITHVALE VIC 3196

barryross@optusnet.com.au

Tel, (03) 9773 3373
(03) 9580 3341
(03) 9786 6687

www.vicnet.net.au/~phillip/m26.htm

The Treasurer, Friends of Edithvale-Seaford Wetlands Inc: I apply to join, rejoin or renew 200...-0...* membership, in the class indicated below. I agree to be bound by the Rules of the Association for the time being in force.

TICK AS TO WHETHER JOINING OR RENEWING	Non-member joining	Member renewing membership
Tick one only please	......................................	.......................................

MEMBERSHIP CLASS	Family Membership*	Individual Membership*	Corporate *	Concession*	Donation to the Society	TOTAL
SUBSCRIPTION	$15.00	$10.00	$20.00	$5.00
AMOUNT PAID	$..............	$.................	$............	$...............	$................	$.............

.	# # Dr/Mr/Mrs/Ms/Miss # # (# Please circle appropriate titles)	Given Name(s)
Surname(s)	..................................................	Address	.............................................................
Postcode	..................................................	Telephone No. Home	.............................................................
Tel. No. Business	..................................................	E-mail address	.............................................................

YOUR WETLAND INTERESTS	PLEASE INDICATE BELOW
Bird watching
Nature study
Education
Plants
Other
CAN YOU HELP US?
Manning hide
Tree planting
Publicity
Typing
Other
HOW DID YOU LEARN ABOUT US?
Visit to bird hide
Brochure
Newspaper
Told by friend
Other

Signature of Applicant ............................................................................. Date ..................................200....