Membership form for Wildflower Society

Wildflower Society of Western Australia (Inc)

MEMBERSHIP APPLICATION & SUBSCRIPTION FORM

Either: Print out and complete this form, then send it with payment to: The Secretary, PO Box 519, FLOREAT, WA, 6014
, Australia
; Or: If you intend to pay by Visa, Mastercard or Bankcard, save yourself postage by using our Email membership form

Family Membership	$52.00
Single Membership	$44.00
Overseas Membership	$52.00
Concessional Membership (Students, Pensioners, etc)	$33.00
Newsletter only (Ordinary Members)	$33.00
Concessional Membership (Newsletter only)	$21.00
Junior Membership	$17.00

Membership commences on receipt of the subscription by the Society and is renewable on each anniversary. Family, Single and Concessional membership includes our Newsletter and the "Australian Plants" journal

Mr/Mrs/Miss/Ms/Dr (Surname) __________________________ (Given Name/s)_________________________________

Address:______________________________________________________;

____________________________________________ Postcode ____________

Email address______________________________________ Phone Number______________________________

Membership type_____________________________________ Amount $_____________

Payment Method:

Cheque made payable to Wildflower Society of W.A. (Inc.)      Money Order OR
Charge to my credit card: Visa   Mastercard    Bankcard.
Card Number:

Expiry Date: ________________ Cardholder's Name:____________________________________

Cardholder's Signature: _________________________________________