Fauna Rescue Of South Australia Overseas Membership Application Form

APPLICATION FOR MEMBERSHIP

I/WE WISH TO APPLY FOR MEMBERSHIP TO FAUNA RESCUE OF S.A. INC.

Mr/Mrs/Ms......................................................	.......................................................................	.........................................................................
Surname	BLOCK LETTERS PLEASE	Given Names

Postal Address................................................	.......................................................................	.........................................................................
.......................................................................	Suburb............................................................	Post Code.........................................................
Residential Address.........................................	.......................................................................	.........................................................................
.......................................................................	Suburb............................................................	Post Code.........................................................

Phone: Home.................................

Work.............................................

Mobile...........................................

Fax................................................

Birth Date....../....../......

Email....................................................................................................

ANNUAL OVERSEAS MEMBERSHIP - US$30

Overseas members will receive a copy of our newsletter printed bi-monthly.

I would like to add a donation of ..............................................

Cheques should be made payable to Fauna Rescue of S.A. Inc. and forwarded to:
Fauna Rescue of S.A. Inc.
P.O. Box 241
Modbury North
South Australia, 5092
Please note that acceptance of this application for membership is conditional on the following, which must be signed by ALL parties to the proposed membership. The committee of Fauna Rescue have the right to refuse any application for membership if they feel the best interests of the organisation are unlikely to be served.

1. I/We have no convictions whatsoever relating to animals

2. Fauna Rescue of S.A. Inc. accepts no responsibility for loss, damage or injuries resulting from activities undertaken by members.

Each applicant must sign below or we cannot accept your membership application.

Sign Here.............................................................................................

Date......................................................................................................

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Date.............................................

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Any enquiries regarding this form please contact the Membership Steward at info@faunarescue.org.au

Family Memberships - please give names of any family members not included on front page..........................................................................................................................................................................................................

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.Are you a member of any other animal organisation?....................................................................................................................................................................................................................

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Office Use Only

Payment $...................

Donation $....................

Received.......................

Member No..................

Signed..........................