TAX INVOICE
ABN: 76 179 048 350

ENVIRONMENTAL DEFENDERS OFFICE (SA) INC

MEMBERSHIP FORM

Members receive regular newsletters about the EDO and current environmental law issues.

I wish to join the Environmental Defenders Office (SA)

Name……………………………………. Signature…………………………………….…………

Address..........................................................

........................................................................ E-mail...................................………………………….

Telephone: (work)........................................ (home)........................………… Facsimile...........................................

New Membership OR  Renew

I enclose my annual fee of
(please circle )

$44.00                    $22.00 – concession                $99.00 – corporate (includes law firms)         $44 corporate concession    (all GST inclusive)

Donation $.........…….…. (pay no GST on this)

Total $.........……….

Payment (CHEQUE, MONEY ORDER, CASH) enclosed

or Credit card (circle one) Visa Mastercard Bankcard

Name on Card…………………………………..……….…….Signature………………………………………………….

Card No _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiry Date:……………

All memberships expire on 30^th June