|
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
|