Membership form

Application to Become a Friend of Meelup

Please complete the form below. All fields with an asterisk (*) are required.

Friends of Meelup Regional Park
BSB: 633 000
Account Number: 164477747
Reference: (Full Name or Surname and Initial)

TYPES OF MEMBERSHIP

Types of Memberships:
No member can belong to two or more classes of membership:*

Ordinary Member (Indefinite Term): $50 Ordinary Family (Indefinite Term): $75 Junior (Term until 18 years): Free

Lifetime/honorary (Lifetime term): Awarded Affiliated Member & Corporate Member: TBA

Any additonal support would be much appreciated $

APPLICANT DETAILS - all fields are compulsory:

Full Name:*

Date of Birth:*

Email Address:*

Phone/Mobile:*

Postal Address:*

SKILLS / INTERESTS / QUALIFICATIONS

Relevant Skills/Interests/Qualifications:

1000 characters left

Other training, interests:
e.g. citizen science projects, fauna monitoring, weed control, education, writing, photography, grants, accounting etc.

1000 characters left

ADDITIONAL FAMILY MEMBERS
One:

Name:

Date of Birth:

Interests:

Two:

Name:

Date of Birth:

Interests:

Three:

Name:

Date of Birth:

Interests:

TERMS AND CONDITIONS
By making payment I/we have read, understood and support the object and purposes of Meelup Regional Park (FOM)

Do you give permission for your photo to be used in promotional material?*

Yes No

Date:*

Payment Details:
Friends of Meelup Regional Park
BSB: 633 000
Account Number: 164477747
Reference: (Full Name or Surname and Initial)