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Wildflower Society of Western Australia (Inc)MEMBERSHIP APPLICATION & SUBSCRIPTION 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 |
Mr/Mrs/Miss/Ms/Dr (Surname) __________________________ (Given Name/s)_________________________________
Address:______________________________________________________;
____________________________________________
Postcode ____________
Email address______________________________________
Phone Number______________________________
Membership type_____________________________________
Amount $_____________
Payment Method:
Expiry Date: ________________ Cardholder's Name:____________________________________
Cardholder's Signature: _________________________________________