NPA Membership Application Form

I/We would like to join the National Parks Association of NSW Inc
and agree to be bound by the rules of the Association.

SURNAME (block letters) ........................................................

OTHER NAMES ......................................................................

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

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

POSTCODE ...............................

PHONE (H) ................................. (W) ........................................

�ADULT $43 � HOUSEHOLD $48

�CONCESSION $23 (circle appropriate category)
              Full-time student/Unwaged/Pension

�SCHOOL/LIBRARY $50 �CORPORATE $200

�DONATION $
               (donations of $2 or more are tax deductible)

�OPTIONAL INSURANCE CONTRIBUTION
                 $3 per person to Confederation of Bushwalkers Insurance Scheme

� I can help NPA with ..........................................................................................

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

$ ........................................................................................

being subscription for .......................................... year(s).

OR please charge my Mastercard/Bankcard/Visa
                                     (circle appropriate category)

No ...........................................................................

Expiry Date ..............................................................

Please accept your first copy of the National Parks Journal as receipt of membership.
A separate receipt will be issued for donations.

Signature ......................................................................

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