AUSTRALIAN GIFT MEMBERSHIP FORM Please indicate your membership type (all rates are GST inclusive):
BirdLife Australia Membership
(includes Australian Birdlife magazine and e-AFO and e-Emu
BirdLife Australia Membership Tax Invoice ABN 75 149 124 774
journals)
Gift Recipient Details (Please write clearly in BLOCK letters) Member #
(if known)
_____________ Mr / Mrs / Ms / Miss /Dr
(circle one)
Name_________________________________________________ FIRST NAME
LAST NAME
Address_______________________________________________ Suburb______________________State______Postcode________ Phone (H)____________________ (W)_____________________ Email_________________________________________________ ORGANISATIONS PLEASE PROVIDE A GENERIC EMAIL SUCH AS info@ or mail@
Organisation Name______________________________________
PLEASE PROVIDE AN INDIVIDUAL CONTACT BY FILLING OUT THE FIELDS ABOVE
Second family member details (for Family memberships) Mr/Mrs/Ms/Miss/Dr _____________________________________ FIRST NAME
LAST NAME
Email_________________________________________________ Child member details (for Family/Stickybeak memberships) Child #1 ______________________________________________ FIRST NAME
OR
BirdLife Australia Membership – with Emu only Paper $105 (Does not include Australian Birdlife magazine; Not available to Concession or Group/Business +5 employees categories) ADDITIONAL SUBSCRIPTIONS - Only available with BirdLife membership
Emu Austral Ornithology
Concession* $60*
(Not available to Group/Business +5 emp category)
Paper copy Western Australian Bird Notes World Birdwatch
$70 $24 $48
BirdLife Photography
$10
(BirdLife International publication)
Donation (tax deductible over $2)
Child #2 ______________________________________________ FIRST NAME
LAST NAME
$ ___________
Send me information about the Wildbird Fund regular giving program
ARA $________ ASG $ _________ AWSG $ __________ ARA: $30 Individual / $35 Family / $45 Institution
Date of birth __ __ / __ __ / __ __ __ __
ASG: $22 Individual / $16.50 Concession / $28 Institution
Gift Giver Details (if known)
$49** $29** $25
LAST NAME
Date of birth __ __ / __ __ / __ __ __ __
Member #
Concession* $58* $100*
Individual $79 Family (2 adults + up to 2 children u14) $125 Group/Business (5 employees or less) $125 Group/Business (+ 5 employees) $200 Student with magazine (incl free e-Emu sub) Student (e-magazine Only; incl free e-Emu sub) Stickybeaks (for children under 14)
AWSG: $40 Individual AUS-NZ / $45 OS Individual / $50 Institution
_____________ Mr / Mrs / Ms / Miss /Dr
(circle one)
Name_________________________________________________ FIRST NAME
LAST NAME
Address_______________________________________________ Suburb______________________State______Postcode________ Country______________________________________________
Total amount enclosed
$ _________
Payment Details: Cheque/money order
Credit Card
Please debit this amount for a 12 month membership Credit Card:
Mastercard
Visa
Phone (H)____________________ (W)_____________________ Mobile________________________________________________ Email ________________________________________________ Send new member pack to: Send renewal notices to: YOU CAN:
giver
giver
recipient
recipient
Join/Renew online at support.birdlife.org.au
OR by fax on +61 3 9347 9323
OR Post this entire sheet with payment to: BirdLife Australia Supporter Services Suite 2-05, 60 Leicester Street Carlton VIC 3053
Yes, I would like a receipt sent by email Printed on 100% post-consumer waste recycled paper
Expiry date: Cardholder Name: Signature:
/ ______________________________
___________________________________
Annual Auto-Renewal
Renew my membership automatically by debiting this amount from * Direct Debit
or Credit Card
annually until further notice.
*Direct Debit: Use the DDR form overleaf and return by post (original signature required).
or by post
*Concession: Health Care/Pension card #........................... **Students: Student ID#/School name .............................
