Membership Form

Please provide your personal details here then do a Bank Transfer *

One Year Individual $15*
One Year Family (2 Adults and all Kids) $25

* Make Payment via Bendigo Bank - Account: Lamington Natural History Association BSB: 633000 Account: 172583916 Reference: SUBS and your Surname. If your Bank app offers the option please send a receipt email to treasurer@lnha.org.au

Name

First

Last

Confirm Email

Phone Contact

Landline and/or Mobile Contacts

Postal Address

A Physical Delivery Address, please include your Suburb and Postcode

Family 2nd Adult

First

Last

2nd Adult Email

First Child

First

Last

Children under 18 receive free Membership

First Child Email

If your child would like to receive the Newsletter please supply an email address

Second Child

First

Last

Children under 18 receive free Membership

Family * Email

Second Child Email

If your child would like to receive the Newsletter please supply an email address