Membership Application Form
Two Birds Logo PO Box 29 Wentworth Falls NSW 2782
Phone: (02) 4757-1872 Fax: (02) 4757-1753
E-Mail: bmcs@bluemountains.org.au
Web Site: www.bluemountains.org.au

Please print this web page, fill in the form below, attach a cheque or money order and post to:
Blue Mountains Conservation Society Inc. PO Box 29, Wentworth Falls, NSW 2782

Please note that when applying for household membership, every member of the household who wishes to join must write their name and sign in the table below
If you intend to join the bushwalks conducted by the Society, the cost of insurance (public liability and personal accident insurance) is $15 per walker, per annum   This insurance cover is compulsory for all walkers.

I/we agree to support the Mission, Aims and Objectives of the Blue Mountains Conservation Society.

Name Signature Bushwalker Y/N
     
     
     
     

Address ___________________________________________________________

______________________________________________  Post Code ________

Phone: (___)_____________________ Mobile: ____________________ Email: _______________________

Do you wish to be notified by e-mail when the Society's magazines "Hut News" and "Strobos" are available on the Society's Website instead of receiving printed copies by post.
Electing this option (below) will help the Society contain membership costs.

Yes - Website only   /   No - Copies by post     (please circle one)

Category Amount Amount Included
Single $25 $
Concessional $15 $
Household $30 $
Concessional Household $20 $
Quoll Club $10 $
Walker's Insurance Levy $15 per WALKER $
Donation $
Total included $