Men of the Trees

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:

1 year Single at $30.00 2 year Single at $60.00

1 year Family at $45.00 2 year Family at $90.00

1 year Concession at $20.00 2 year Concession at $40.00

1 year Corporate at $100.00 2 year Corporate at $200.80

Life Membership at $350.00

(Prices include G.S.T and any Postage and Handling Costs)

Title	First Name	Last Name

Address

Telephone (Daytime):

Mobile:			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 !