Clarence Landcare Individual Membership Form

Individual Member Application Form

Application forms are approved at monthly management committee meetings. Your email address will then be added to the Newsletter List. If you do not receive a Newsletter toward the end of the month, check your SPAM inbox to make sure you accept Clarence Landcare emails.
Name

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Address (If Different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone

Area CodePhone Number
Mobile

+61Phone Number
Do you manage a rural property?
Are you a member of a Landcare group?
If yes, name of group
If you're not a member of a Landcare group, would you like to join a group near you?
Are you on Facebook?
Clarence Landcare Facebook
For new members interested in canetoading, do you consent to us sharing your phone number and email address with other members of the network (ie those interested in joining up for canetoading)? Your details will not be shared elsewhere, this is an opt-in for volunteer members to join a network of cane toad collectors.
Certificates/Qualifications
Please indicate if you have a current certificate/qualifications in the following:

Other
Areas of Interest
Please indicate your areas of interest

Other
Code of Conduct for Members, Groups and Volunteers

(if link does not work the one page document can be found on www.clarencelandcare.com.au/about/governance )
I have read and accept the Clarence Landcare Code of Conduct, link above.
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Thank you for taking the time to complete the above information.

Clarence Landcare Inc

Suite 1, 48 Prince Street, Grafton. NSW. (Upstairs) || PO Box 594, Grafton. 2460 Ph: (02) 66435009

Email: landcare@clarencelandcare.com.au

Landcare membership is currently free. This may change in the future. Your membership application form will be presented for approval at the next monthly Clarence Landcare management committee meeting.
Should be Empty:

Individual Member Application Form

Certificates/Qualifications

Areas of Interest