New Member or Membership Renewal? (Please tick): New Member Membership Renewal
Full name:			Email address:
Address:			Postal address (if different):
Home Phone:			Mobile phone:
Type of Membership: (Please tick box)
1. Annual Membership $15.00
2. Donation $
3. A monthly payment of $10 or more by Direct Debit, please specify amount: $
4. Adopt an Eagle: $2,000 annually. Contact the Raptor Refuge for details.
All donations will assist in the developmental activities of Raptor & Wildlife Refuge of Tasmania Inc.
Please tick here if you would like your newsletter to be e-mailed to you instead of posted.

Preferred Payment Options:

Direct deposit:
Bank name: MyState Financial Credit Union of Tasmania
BSB Number: 807007
Account Number: 51391725
Account Name: Raptor and Wildlife Refuge

Note: If you are paying by direct deposit, please either scan and e-mail this form and your receipt to craig@raptorrefuge.com.au; or mail to the address below.

If you are paying by cheque, please complete the details on this form and then mail this with your payment to:

RAPTOR & WILDLIFE REFUGE OF TASMANIA INC
CRAIG WEBB
PUBLIC OFFICER
PO BOX 108
KETTERING TASMANIA 7155

Applicants Signature:

Members will receive a periodical newsletter on the plight of Tasmanian endemic raptors and native wildlife. It will also detail the highlights of a behind the scenes look at what Raptor & Wildlife Refuge of Tasmania Inc. has achieved. As a member of an incorporated association, you will also receive invitations to Annual General Meetings (attendance is optional).
Members will also be invited to open days, where everyone can meet and discuss issues affecting our community. Being a member of the R&WR of T Inc, you will have the satisfaction of knowing that you are helping Tasmanian threatened species.