Application for membership of the Field Naturalists Association of Canberra (FNAC)
Name  ______________________________________________________

If a household membership please include other member/s of the household joining.

____________________________________________________________

Address  ____________________________________________________

Suburb  ________________ 

State  _____________ 

Postcode  ________

Phone (Home)  _______________

          (Other)  ________________

Email  _________________________________
How did you hear about FNAC?

Friend            Flyer/poster          FNAC website          Other
Please print off this form, complete it and send it with a cheque for $20 payable to "FNAC" to: Treasurer, FNAC, GPO Box 249, Canberra ACT 2601
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