Men Of The Trees Western Australia
Membership Application Form

Make cheques made payable to 'Men Of The Trees Inc.'

I would like to join Men Of The Trees WA for a period of:

2 year Family at $63.80 1 year Family at $33.00

2 year Single at $52.80 1 year Single at $27.50

2 year Concession at $30.80 1 year Concession at $16.50

2 year Corporate at $107.80 1 year Corporate at $55.00

Life Membership at $275.00 (Prices include G.S.T and any Postage and Handling Costs)
Title First Name Last Name
Address
Telephone (Daytime):  
Fax: E-mail:

Cheque Payment of $ is enclosed or charge $ to Credit Card
Mastercard Visa   Expiry Date /
Card No:


Cardholders Name (as on card):


Cardholders Signature: ____________________________________

Do you Authorise Men of the Trees Inc. to publish your name in Newsletters or acknowledgements in any of their publications ?
Yes No




Complete and then Print the form
(Your Privacy will always be respected - no details divulged to any third parties)
Mail the completed form to: PO Box 103, Guildford, WA 6935
OR Fax your membership form to (08) 9250 2735
Don't Forget to Sign Your Name ... AND ... Thanks ... for your support !