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GIFT MEMBERSHIP APPLICATION20104166274

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GIFT MEMBERSHIP APPLICATION20104166274 Powered By Docstoc
					                                NATIONAL TRUST of AUSTRALIA (VICTORIA) 
                                                                   ABN 61 004 356 192


                                     GIFT MEMBERSHIP APPLICATION
TO GIVE A GIFT MEMBERSHIP OF THE NATIONAL TRUST, PLEASE COMPLETE THIS
MEMBERSHIP APPLICATION AND FORWARD THE COMPLETED FORM, WITH YOUR
PAYMENT TO:
        Membership Department
        The National Trust of Australia (Victoria)
4 Parliament Place, East Melbourne Vic 3002 or Fax: 03 9650 5397

I would like to give a GIFT MEMBERSHIP to:

Dr/Mr/Mrs/Ms__________________________________________________________________________
                          Surname/Surnames
First Name )____________________________________________________________________________

Address_______________________________________________________________________________

____________________________________Postcode____________________________

Telephone (H): ____________________(B)_________________________ Mobile ___________________


MEMBERSHIP CATEGORY
  Single                                                              $56
  Household (2 adults, children under 18)                             $80
  Single Concession (pensioner of full-time student)                  $41
  Household Concession (pensioner of full-time student)               $56
Joining Fee                                                           $33
Total

YOUR NAME
Dr/ Mr/ Mrs/ Ms/ Miss _______________________________ (Surname)

Name______________________________________

Address________________________________________________________________

__________________________________________________________ Postcode __________________

Telephone (H): ____________________(B)_________________________ Mobile ___________________

PAYMENT DETAILS
Herewith:              Cash       Cheque                                Cardholders Name_________________
Or charge               Visa/BC/MC    Amex                Diners



Expiry______________________Signature_____________________


  Send membership package to me


  Send membership package to the gift recipient


                                                                                               Internet

				
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Description: GIFT MEMBERSHIP APPLICATION20104166274