NORTH WEST BIRD CLUB INCORPORATED.

APPLICATION FOR MEMBERSHIP

I wish to become a member of the North West Bird Club Inc.

NAME…………………………………………………………………………………………………

ADDRESS…………………………………………………………………………………………….

PHONE……………………..…DATE OF BIRTH (Junior Members only)………………………

SIGNED…………………………………….…Date…………………………………………………

If this is a Family application please state first names below.

NAME……………………………………….DATE OF BIRTH…………………………………….

NAME……………………………………….DATE OF BIRTH…………………………

NAME……………………………………….DATE OF BIRTH…………………………

NAME……………………………………….DATE OF BIRTH…………………………

TYPE OF MEMBERSHIP (Please circle)

FAMILY / ADULT / PENSIONER FAMILY / PENSIONER ADULT / .JUNIOR

SUBSCRIPTION DETAILS

Family……………….. $13.00 Return with subscription to:

Adult………………….$10.00 North West Bird Club Inc.

Pensioner Family….....$10.00 PO Box 59

Pensioner Adult……….$7.00 Wynyard

Junior…………………..$4.00 Tas. 7325

BIRDS KEPT (Please note - this is not compulsory to complete.)

……………………………………………… …………………………………………………………

…………………………………………………………………………………………………………..

President.