RENEWAL FORM

GROUP:         BLUE MOUNTAINS

All adults who participate in Group activities

regularly should be covered by membership.

Joint Membership may include 2 adults who

choose to use the same address.

Each receive a membership card.

PRINT CLEARLY

SURNAME/S     ……..........................……...........……....…..…   …...………………………………………………

GIVEN NAME/S     ……..................................................………      …....……...................................................…..

MAILING ADDRESS         …………………………………………………..…….………………………………………  ..........................................................….....…........…......…....       POSTCODE    …….........................................

Is this a CHANGE OF ADDRESS?  (Circle)    YES     NO       Previous Postcode     ..………..............................

PHONE     Home    ........…...........................….....….......…....        Work   …………………...............…...............

FAX     .....................................................…...      EMAIL        ..................…....…………...................................…

We  /  I belong to another  DISTRICT GROUP     YES     NO      …….........……………………............................

We / I belong to STUDY GROUP/S    ........................................................….........………………………..............

INTERESTS / SKILLS     ..............................................................................…...........……………........…………..

..........................................…............................................................................……………...................................

Do you currently hold an office or perform specific tasks in your Group?      YES     NO

Would you VOLUNTEER assistance in the Society's activities in an area convenient to you?   YES    NO

If you would like to send a Gift Membership see Renewal Form in “”Native Plants for NSW”.

 

TYPE OF MEMBERSHIP        Rates as at 1 January 2008     Includes GST

INDIVIDUAL                              $50.00              ‘        Concession       $42.00              ’

JOINT MEMBERS                     $58.00             ’        Concession       $50.00              ‘

A Concession is available to Seniors, people on a limited fixed income and full-time students. 

This applies in joint memberships where one person is entitled to request it.       Please give reason.

………..………………………………………………………………………………………………………………………

YOUR aps MEMBERSHIP CARD NUMBER        ………………….…………………………..

  ‘ Cheque       ‘    money order made payable to Australian Plants Society Blue Mtns Gp

OR                   Please charge my:                    Mastercard    ’     Visa    ‘

Credit Card No      ****   ****   ****   ****

Card Expiry Date      ……………   /   ……..............

Card Holder's Name   ..….......................................    Card Holder's Signature   …..……....................................

Receipts will be issued on request by your Membership Officer.

Statements for tax purposes will be provided if a stamped, self – addressed  envelope is provided.

Renewals may be left in the appropriate folder at the Reserve.   

Post payments and direct all membership problems/inquiries to:

Australian  Plants – Blue Mountains

Membership Officer

PO Box 23

                                                                     Glenbrook NSW 2773

ABN 87 002 680 408