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INTERNATIONAL MEMBERSHIP FORM BirdLife Australia Membership with magazine (includes printed Australian Birdlife magazi...

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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 #..........................