Mordialloc Beaumaris Conservation League Inc.

A0021849H Victoria

1 Montgomery Street, MORDIALLOC 3195

Telephone
(03) 9580 2706

www.vicnet.net.au/~phillip/m9.htm

The Treasurer, Mordialloc Beaumaris Conservation League Inc: I apply to join, rejoin or renew 2001-02* Mordialloc Beaumaris Conservation League Inc. membership, in the class indicated below. I agree to be bound by the Rules of the Association for the time being in force.

TICK AS TO WHETHER JOINING OR RENEWING	Non-member joining MBCL Inc.	Member renewing membership
Tick one only please	......................................	.......................................

MEMBERSHIP CLASS	Family Membership*	Individual Membership*	Concession Membership	Donation to the Society	TOTAL
SUBSCRIPTION	$10.00	$10.00	$5.00
AMOUNT PAID	$..............	$.................	$...............	$................	$.............

.	# # Dr/Mr/Mrs/Ms/Miss # # (# Please circle appropriate titles)	Given Name(s)
Surname(s)	..................................................	Address	.............................................................
Postcode	..................................................	Telephone No.	.............................................................
Fax No.	..................................................	E-mail address	.............................................................

Please make cheques or money orders payable to 'Mordialloc Beaumaris Conservation League Inc.'

Signature of Applicant ............................................................................. Date ..................................2001