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: |
$20 per annum |
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¨ Concession: |
$10 per annum (students, concession card holders) |
(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
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) | |||
