Membership 2018-19
MEMBER INFORMATION		
NAME:		
PHONE:	MOBILE:	
POSTAL ADDRESS:		
TOWN:	STATE:	
EMAIL:		
SIGNATURE:		
DESCRIPTION	DATE	AMOUNT	
ANNUAL MEMBERSHIP FEE		(GST inc)                                       $10	
PAYMENT DETAILS		
        EFT TRANSFER
BSB:  932 000   ACC:  756381S3   
ACC NAME:  Dandarrga Landcare                     REF: Surname	         CASH/CHEQUE
(Payable to Dandarrga Landcare)	
	Rec.#	
If applicable, please print, enclose and mail; or scan and email this membership form with your cheque or direct deposit confirmation number, and we will email / post a receipt.
COMMENTS: