APPLICATION FOR MEMBERSHIP
New Members only

Send to     The Treasurer, Australian Plants Society Tasmania Inc.
                  PO Box 3035, ULVERSTONE MDC, Tasmania  7315
                 Australia

Name(s)
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                                            (For Household membership include names of all members nominating)

Address........................................................................................................................................................

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Postcode...............................Phone...........................................................Fax..............................................

Email.............................................................................................................................................
Subscription period
1 year
Amount paid
Regular (Individual) including
Organisations

$40.00

*Concession membership (Please check
appropriate box below)

$37.00

Each additional adult included in Household
Membership (Regular or Concession)

$9.00

Each additional child included in Household
Membership (Regular or Concession)

$1.00

**Overseas Member or
Overseas Organisation

$55.00

Australian Plants Journal
$14.00

#Total Amount Tendered:           $
*Concession subscription rates are offered to holders of a Pensioner Health Concession Card issued by Centrelink
or the Department of Veterans Affairs, or of a Student ID Card
Please check the appropriate item below if you are eligible for the concession
I have a Pensioners Concession Card from Centrelink (   ) DVA (   ); a Student ID Card (   )
**Paid by Bankers Draft in $Australian
# Subscription payments may be made directly into the Society's account at a Westpac bank or by Electronic Funds                 Transfer if convenient. Please identify the payment with your surname.
Account details are:
                Name:  Australian Plants Society Tasmania Inc.
                BSB:                     037-015
                Account number:   194644
Please complete the item below:
I agree to abide by the rules of the Society and enclose $...................................................Subscription fee.

Signature............................................................................................................date............./......../.............