Membership form for Wildflower Society

Please circle required membership

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, Wildflower Society, 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

Membership Category	Cost (without Australian Plants journal)	Cost (with Australian Plants journal)

Family	$55.00	$70.00
Single	$45.00	$60.00
Overseas	$55.00	$70.00
Concession*	$30.00	$45.00
Junior	$10.00	$25.00
Affiliated Group	$45.00	$60.00

*full-time students, pensioners, seniors card holders

Membership commences on receipt of the subscription by the Society and is renewable on each anniversary.

Mr/Mrs/Miss/Ms/Dr (Surname) __________________________

(Preferred Given Name/s)_________________________________

Address:______________________________________________________

____________________________________________ Postcode ____________

Email address______________________________________ Phone Number______________________________

Membership type_____________________________________ Amount $_____________

Concession card number________________________

Payment Method:

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

Expiry Date: ________________ Cardholder's Name:____________________________________

Cardholder's Signature: _________________________________________

I would like to receive the quarterly newsletter in the following format:
Email only Hardcopy only Both Email and Hardcopy