Membership application form

MEMBERSHIP APPLICATION
 
Membership Subscription -  $25 per property
Financial Year  1^st July – 30 June 2006-2007
 
DATE____________________

FAMILY NAME ____________________________________________________

GIVEN NAMES OF FAMILY MEMBERS _________________________________________________________________________

PROPERTY NAME __________________________________________________

ADDRESS __________________________________________________________

                   __________________________________________________________

POSTAL ADDRESS (if different)_________________________________________

                                                       _________________________________________

TELEPHONE : (Home)_____________________  (Business) ____________________

MOBILE : _______________________________

FAX : __________________________________

EMAIL: ________________________________

 
We agree to abide by the Constitution / Rules of the Otway Barham Catchment Landcare Group

Signed _____________________________________________

 
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Application Received by Secretary :      Date_______________________

 
Application Approved by Committee :  Date   ______________________

 
Membership Subscription Paid :            Date   ______________________

 
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All properties using the services of the Southern Otways Landcare Network must be a fully paid up member of one of the four Landcare Groups which make up the Network.

 
Apollo Bay Landcare Group
Hordernvale/Glenaire Landcare Group
Otway Barham Catchment Landcare Group
Wongarra Landcare Group
 
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