FATS Membership Application Form

(Print and Mail this form)

Title: ____  First name: ____________________

Last Name: ____________________________

Street: _______________________________ 

Suburb: __________________________

State: _________ Postcode:________

Home phone: _______________________ 

Mob: _________________________________

Work phone: _______________________

Email: __________________________________________

(Please tick)

New Membership:  __        Renewal:    __

Single  $30      __        Family $40  __

Additional donation:  $____

Total enclosed:       $____

Direct Debit OR Cheque

Direct Debit National Australia Bank

             Bank Transfer BSB 082 342

             Account Name "Frog and Tadpole Study Group"

             Account Number 28-576-6885

             Identify yourself by Name in Description

Please make out Cheques to “The Frog and Tadpole Study Group NSW Inc”

Send cheque to: 

Membership FATS Group
PO Box 296
Rockdale NSW 2216

Your receipt and membership card will be mailed to you with your first FrogCall. Please keep in mind that it is a bi-monthly newsletter, so it may take up to two months.

Last updated Sat 07-May-2016

   

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