Membership and donation form                     

• join Nature and Society Forum and agree with the principles and working methods [ ]
• renew membership [ ]
• make a tax deductable donation to Nature and Society Forum of  $.....................
  
• find out more about: .......................................................................................

Signature/s........................................................ Date: ...........................................

Address: ...............................................................................................................

....................................................................... Post code: .....................................

E-mail: ............................................................ Telephone: ....................................

(New members of Nature and Society Forum receive a free copy of Our Place in Nature)

Membership fees (Australian dollars)

Payment

 Cheque payable to Nature and Society Forum Inc.

l__l__l__l__l    l__l__l__l__l    l__l__l__l__l    l__l__l__l__l

Cardholder: ................................................................ Expiry date ........../.........

Signature: .......................................................................................................

Membership fee: $................................

Donation (tax deductable): $...................

Total paid: $........................................

Please mail completed form with payment or credit card details to
Nature and Society Forum, GPO Box 11, Canberra ACT 2601
or fax to 02-6125 1756

This page updated last on 10 July 2008