INTERNATIONAL MEMBERSHIP FORM
BirdLife Australia Membership with magazine
(includes printed Australian Birdlife magazine and e-AFO and e-Emu journals)
BirdLife Australia Membership Tax Invoice ABN 75 149 124 774
Individual Family (2 adults + 2 children under 14) Group/Business (5 employees or less) Group/Business (+ 5 employees)
Your Details (Please write clearly in BLOCK letters) Member Number Title
(if known)
_______________
Mr / Mrs / Ms / Miss /Dr
OR
BirdLife Australia Membership with e-magazine
(circle one)
(includes electronic Australian Birdlife magazine and e-AFO
Name_________________________________________________ FIRST NAME
Concession* $115* $155*
$135 $177 $177 $230
LAST NAME
Address_______________________________________________ Suburb______________________State______Postcode________ Country______________________________________________
journal)
Individual Family (2 adults + 2 children under 14) Group/Business (5 employees or less) Group/Business (+ 5 employees) OR
Concession* $85* $125*
$105 $147 $147 $200
Mobile phone__________________________________________
BirdLife Australia Membership – with Emu only Paper $127
Email_________________________________________________
Concession or Group/Business +5 employees categories)
ORGANISATIONS PLEASE PROVIDE A GENERIC EMAIL SUCH AS info@ or mail@
Organisation Name______________________________________
PLEASE PROVIDE AN INDIVIDUAL CONTACT BY FILLING OUT THE FIELDS ABOVE
(Does not include Australian Birdlife magazine; Not available to
ADDITIONAL SUBSCRIPTIONS - Only available with BirdLife membership
Emu Austral Ornithology
(Not available to Group/Business +5 emp category)
Second family member details (for Family memberships)
Paper copy
Mr/Mrs/Ms/Miss/Dr _____________________________________
Western Australian Bird Notes BirdLife Photography
FIRST NAME
LAST NAME
Mobile phone __________________________________________ Email_________________________________________________
$100 $24 $10
Donation (tax deductible over $2)
$ ___________
Send me information about the Wildbird Fund regular giving program
Child member details (for Family/Stickybeak memberships)
ARA $________ ASG $ _________ AWSG $ __________
Child #1 ______________________________________________
ASG: $22 Individual / $16.50 Concession / $28 Institution
FIRST NAME
LAST NAME
Date of birth __ __ / __ __ / __ __ __ __
AWSG: $40 Individual AUS-NZ / $45 OS Individual / $50 Institution
Total amount enclosed
Child #2 ______________________________________________ FIRST NAME
ARA: $30 Individual / $35 Family / $45 Institution
LAST NAME
Payment Details: Cheque/money order
Date of birth __ __ / __ __ / __ __ __ __
$ _________ Credit Card
Please debit this amount for a 12 month membership
Help us get our records straight, do you know your join date?
Credit Card:
Mastercard
Visa
Year:_____________________
YOU CAN:
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
Expiry date: Cardholder Name: Signature:
/ ______________________________
___________________________________
Supporter Services
Annual Auto-Renewal
Carlton VIC 3053
my Credit Card annually until further notice.
Suite 2-05, 60 Leicester Street
Yes, I would like a receipt sent by email Printed on 100% post-consumer waste recycled paper
Renew my membership automatically by debiting this amount from
or by post
*Concession: Unemployed/Pension card #..........................