Family Bushwalkers Inc.

Application for membership

Our membership year is 1 October to 30 September. You will receive 15 months
membership if you join after 1 July. You may apply for single or family 
membership. Please fill in your details below.

I wish to apply for membership in Family Bushwalkers Inc., and enclose the
fee indicated. The type of membership and names of the family members to
be covered by this membership are given below.

I agree to read the 'Information for Members' published in the current
Walks and social program and to abide by the 'Rules for Walkers' outlined
therein. I acknowledge that I will be taking part in Family Bushwalkers
activities in a voluntary capacity and do so at my own risk.

I enclose my membership subscription as shown below.

  Please circle one:	Single $20 	Family $30 

  Please circle one:	Renewal 	New member 

GIVEN NAMES				FAMILY NAMES
______________________________________	______________________________________
______________________________________	______________________________________
______________________________________	______________________________________
______________________________________	______________________________________
______________________________________	______________________________________
______________________________________	______________________________________

POSTAL ADDRESS:	_____________________________________________
	_____________________________________________
	_____________________________________________
	_____________________________________________
		         Postcode:	__________________

TELEPHONE: Home:	         Work:	              Mobile:

E-mail address (for urgent communications):     _______________________________

Do you wish to receive future programs by E-mail? (Please circle one) Yes/No

SIGNATURE:	_______________________________   Date:

Please send the completed form and payment to:
The Secretary, Family Bushwalkers Inc., 166 Belconnen Way, Scullin ACT 2614