AUSTRALIAN PLANTS SOCIETY (NSW)

MEMBERSHIP APPLICATION

Print out and complete this form, then send it with payment to the address below

TYPE OF MEMBERSHIP (tick appropriate box)

Single Membership; Standard ($50 per year)	[__]
Single Membership; Concession* ($42 per year)	[__]
Joint Membership** Standard ($58 per year)	[__]
Joint Membership*; Concession ($50 per year)	[__]
New Zealand Membership ($AUS46 per year)	[__]
Overseas Membership ($AUS60 per year)	[__]

* Concession applied for......Limited Fixed Income [__] Full Time Student [__]
** 2 persons at the same address - each receive a membership card

MEMBER DETAILS (Joint members please complete "A" & "B")

A. Mr/Mrs/Miss/Ms ____________________________________________________

Name _______________________________________________________

B. Mr/Mrs/Miss/Ms ____________________________________________________

Name _______________________________________________________

Postal Address ______________________________________________________

____________________________________________Postcode_______________

Telephone (___)_______________________ Business (___)___________________

Fax (___)______________________ Email Address _________________________

PAYMENT DETAILS (fees cover a full 12 month's membership)

Payment of $________ is enclosed by Cheque/Money Order.

Please charge my..........Mastercard [__] Visa [__]

Card Number: |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__|

Card Holders Name (Please Print Clearly):________________________________

Expiry Date: ___________ Card Holders Signature:_________________________

Please make cheques payable to SGAP NSW Ltd and return the completed form with payment to:

Membership Officer,
Australian Plants Society,
PO Box 38,
WOODFORD, New South Wales, Australia, 2778

or FAX to: Membership Officer: 02 4758 7169

Please direct all membership problems/ enquiries to:
Phone: 02 4758 6637
Email: callitris2@bigpond.com

SOME HELPFUL INFORMATION.....

We would appreciate the provision of the following information by all members. Your responses will help us plan our activities and publications to best meet members' needs. This material will also assist us to present an accurate picture of our Society to government and corporate agencies which can help us further our aims.

The information provided will not be used to enlist any greater level of commitment than you wish to give to the Society. It will be used only within the interests and activities of the Society.

My/our interest in Australian native plants is GENERAL/SPECIFIC

Details of interest/skills:_______________________________________________

_________________________________________________________________

Please tick appropriate age group(s):

Under 16 [__] 17 - 21 [__] 22 - 29 [__] 30 - 39 [__]

40 - 49 [__] 50 - 59 [__] 60 - 69 [__] 70+ [__]

Would you VOLUNTEER assistance in the Society's activities in an area convenient to you?

Yes [__] No [__]

Updated: Sunday 04 May 2008.