General Membership

General Membership Application

Membership Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Pensioner Ref #
Please select the Membership Type that best suits you*

Single - 1 year $25Family - 1 Year $40Junior - 1 year $10 (*parents will need to sign and approve)Pensioner - 1 year $10Pensioner Family - 1 Year $15Lifetime Member $200
*All Fees ANNUAL, except Lifetime Membership
Membership Benefits include:
- Newsletters
- Invitations to upcoming events
- Great Opportunities for further engagement
- Knowing that you are supporting Wildlife in the South West, Western Australia
Applicants Signature*

Clear
Date*

DayMonthYear
Date
Parents Signature (If applicant is under 18 years of Age)

Clear
Date

DayMonthYear
Date
Payment Details

GEO Bay Wildlife Rescue

BSB: 633 000

Acc: 203 064 597

Please use your surname as the reference

You will be notified of the outcome of your application following the next committee meeting.

Thank you
Please verify that you are human*
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General Membership Application