Membership Application November 2009 by lindayy


More Info
									                                    MEMBERSHIP APPLICATION
How much does it cost? (Please Tick)
                                  Individual $40                                   Family $63
                                  Corporate $250                                   Concession $20
Name                    Address                                 Phone             E-Mail

   I understand that the information I provide will only be used for the Hunter Wetlands Centre Australia and
   that it may only be used for its intended purpose. For further information regarding our privacy policy
   please email

 Name                                                  Signature                                 Date

    Payment Methods:
        Card Type            
                             Bankcard           MasterCard           VISA

    Card Number        
      Card Name        
      Expiry Date    /                 CVN

    Signature                      /  /                      Date

    OR Enclosed Cheque For $                                          Or Cash $

    Please either hand form to reception and a receipt will be issued AND/OR fax to (02) 4950 1875 OR Email
    to OR post to Hunter Wetlands Centre Australia, PO Box 292 Wallsend 2287 with
    Credit Card Details or Cheque (receipt will be issued by post)

                                        Membership Details Entered                 Wacky Membership Details Entered
 Please Tick When Complete

 How did you hear about Hunter Wetlands Australia?

  Please tick what                        How do you prefer to
below interests you?                    recieve information from
                                             Hunter Wetlands
                                             Centre Australia?
  Bush Regeneration
                                              Hard Copy
  Bush Walking                                Noticeboards
  Science                              Off the roundabout
  Sports                              (412) Sandgate Road
                                      Shortland NSW 2307
  Education                          Phone: (02) 4951 6466
  Activities                       Email:

             I DO NOT wish to recieve updates (other than those included
             as part of this membership) regarding activities a& events for
             the Hunter Wetlands Centre Australia

         Thank you for becoming a member.


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