Registration for Membership - Application Form

Springfield Lakes Nature Care Inc

Application for Membership
Name*

First NameLast Name
Address*

Address

Street Address Line 2

SuburbState

Postal / Zip Code
Contact Details
email address:*
example@example.com
Mobile Contact Number*
Preferred contact method:

Emailmobile SMS
Membership Category

Annual fee: $10 for individual; $20 for family
Individual

Individual ($10 annual fee)Family ($20 annual fee)
Age Range for both individuals and Families (tick all boxes that are relevant)

Under 1818-3030-4545-6060-75
What activities in doing

Working bees – weedingWorking bees -- tree plantingWorking bees -- litter pickupWorking bees -- toad huntingWorking bees -- letterbox dropsFauna spotting events (day & night)Bush walksMonitoring surveys (citizen science)Identifying and reporting environmental issuesHabitat improvement eg. nest boxes / habitatHosting information stallsAttending environmental workshops
Consent by submitting this form – By signing below, I consent to the use by SLNC Inc. of the above contact details for internal contact regarding group run events, to receive information about how to better care for the environment, and promotional material associated with other events / opportunities that fit within the group’s objectives that the management committee feel that I may be interested in participating in. The SLNC Inc. will not share contact information to third parties.
Date

DayMonthYear
Date
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