Print this page to provide a membership form
Queensland Naturalists' Club Inc.
Application for Membership
Preferred Title Mr / Mrs / Ms / Dr / etc
Surname, Initials ...........................................................................................
Preferred First Name ....................................................................................
Address ........................................................................................................
...................................................................Postcode.......................
Telephone .......................................................................................................
Other Family Members name(s) ......................................................................
.......................................................................................................................
Please include age(s) of Junior or Student Members .........................................
Natural History interests ...................................................................................
........................................................................................................................
Please tick category of membership:
|
Family |
$40 |
|
|
Single |
$25 |
|
|
Student |
$15 |
|
|
Junior (under 18) |
$15 |
Cheque/money order for $ .................... is enclosed, (payable to the Queensland Naturalists Club Inc)
Send to: The Secretary, Queensland Naturalists Club Inc.
PO Box 5663, West End, Qld, 4101