Full-year Form

Dry Tropics Biodiversity Group Inc.
32 Armstrong St.
Hermit Park
Qld. 4812

Phone 4771 6115

MEMBERSHIP APPLICATION FORM
Please print out and complete this form and return with payment to the above address.

FULL-YEAR SUBSCRIPTION (1st April 1999 - 31st March 2000)

New member, ordinary membership- within Australia - 1 person or organization________$20___................

Each additional household member (not requiring separate publications)_____$ 20___................

New member, full-time student in Australia (full year)______________________________$20___................

TOTAL_______................

Cheques/Money Orders should be made payable to "Dry Tropics Biodiversity Group Inc."

If a receipt is required, please enclose a stamped addressed envelope.

TITLE (Mr/Mrs/Miss/etc) ............ FIRST NAME/S ..........................................................

*LAST NAME .......................................................................................................................

POSTAL ADDRESS ...........................................................................................................

............................................................................................................Postcode ...................

TELEPHONE NO. ..........................................(home) .............................................(work)

EMAIL……………………………………

ADDITIONAL HOUSEHOLD MEMBER .......................................................................