Membership Application Form Your first name * Your last name * Email Address * Telephone * Street address * Suburb * Postcode * Membership type * Individual, $75 Family, $100 Student or individual junior, $40 Subscriptions are for the Calendar Year. Renewal is due on the 1st January each year. Applications received after 1st October will be credited to the end of the following year. Subscriptions include 10% GST. Branch Main branch Darling Range branch Kwinana/Rockingham/Mandurah branch Northern suburbs branch Optional. You may choose to be affiliated to a branch. Remember membership entitles you to participate in any or all branches and groups Family membership application: other family members names (and, for those under 18, date of birth) If you are applying for a family/household membership, please enter the name and, for children between 6 and 18 years, the date of birth. By completing this form I/we acknowledge and accept the mission of the Club "to encourage the study and protection of the natural environment". You can pay for your membership by bank transfer, or by sending a cheque or money order. Details will be displayed when you submit this form.