Membership Application and /or Change of Contact Details

Please print this form and post to

The Big Scrub Environment Centre
PO Box 816, Lismore NSW 2480

NAME ........................................................................................................

ADDRESS ..................................................................................................

...................................................................................................................

TELEPHONE ........................................................

E-MAIL .................................................................

Currently Membership subscriptions are under review.
In the meanwhile, a nominal fee of $10 would be acceptable.

All membership fees include 10% GST

Enclosed please find Cheque/Money Order to the value of ............................

Nominating Member .......................................................................................

I agree to observe the rules of the Big Scrub Environment Centre Inc. ..........

Signature of Applicant ....................................................................................

Please mail to:
The Big Scrub Environment Centre,
PO Box 816, Lismore NSW 2480


If you are already a member, you can pass this form onto a friend
who may be interested in becoming a Big Scrub Member.


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