ABN No 21 367 529 654
Membership Application/Renewal Form
Family Name*:……………………………………………………………………………………………
First Name*:……………………………………………………………………………………………....
(if family membership, please list all names)
Address*:……………………………………………………………………………………………….....
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Phone No*:………………………………………...Fax No:…………………………………………….
Mobile Phone: …………………………………………………………………………………………....
Email Address*(if any):…………………………………………………………………………………...
Membership Fees (Please tick) :
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¨ Regular / Family:
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$20 per annum
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¨ Concession:
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$10 per annum
(students, concession card holders)
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(The first year of membership will consist of four full calendar quarters plus the
remaining days of the calendar quarter within which you join.)
I would like to join the Cubberla-Witton Catchments Network Inc.
Date*:………………… Signature*…………………………………………………….
* compulsory
Please fill out the questionnaire below.
Please mail application to:
Cubberla-Witton Catchments Network Inc, PO BOX 5200, KENMORE EAST 4069
CWCN-0001
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My main interests are indicated below |
I am happy to support the Network in/with: |
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Waterwatch/water monitoring |
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Website extension/maintenance |
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Bush Care |
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Newsletter creation/editing |
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Native Flora |
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Educational materials/Flyers |
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Native Fauna |
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Creation of Display Material |
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Fish |
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Event Organisation |
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Invertebrates |
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Grant Applications |
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Birds |
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Finding Sponsors |
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Mammals |
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Implementation of Regional NRM Plan(s) |
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Frogs |
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Publicity/Media |
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Lizards |
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Fungi/Lichen |
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General Admin tasks (help with mail-outs, typing, filing etc) |
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Seed Collection/ Plant Propagation |
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Plant Identification/Botanical Information |
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Others:
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I am a member of the following bush care group:
………………………………………………………………………………………………………. |
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I am a member of (other environmental organisations):
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I would like to donate $ ……………
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Payment Method for membership fee / donation |
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In cash |
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Cheque enclosed |
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I have transferred the money to
Account No 203 097, BSB 034 063
Account Name: Cubberla-Witton Catchments Network Inc.
Credit Institution: Westpac Bank, Indooroopilly Shoppingtown
Reference:
…………………………………………………………………………………...
(Very Important!!!!! Please repeat reference used in transaction, preferably your name)
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