Nepean Conservation Group Inc. - Membership Application Form

Nepean Conservation Group Inc. A0020791U Victoria

P.O. Box 157 SORRENTO VIC 3943

Tel (03) 9583 7640, 5988 9239,
Fax (03) 9878 9190

www.vicnet.net.au/~phillip/m14.htm

The Hon. Secretary, Nepean Conservation Group Inc.

I apply to join, rejoin or renew 2001-02 Nepean Conservation Group Inc. 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 SPB	Member renewing membership
Tick one box only please, at right	.............................................	......................................................

MEMBERSHIP CLASS	Family Membership*	Single Membership*	Donation to the Group	TOTAL
SUBSCRIPTION	$20.00	$15.00
AMOUNT PAID	$..............	$.................	$................	$.............

.	# # Dr/Mr/Mrs/Ms/Miss # # (# Please circle appropriate titles) BLOCK LETTERS PLEASE	Given Name(s) SURNAME(S)	............................................................. ............................................................
Address & Postcode	..................................................	Peninsula Address & Postcode	.............................................................
Telephone No.	..................................................	Peninsula Telephone No.	.............................................................
Fax No.	..................................................	E-mail address	.............................................................

(Note: Receipts sent only on request) Signature of Applicant ..................................................................................... Date ....................... 20.....