Membership Form

For New Memberships, Renewals & Change of Address,

please complete the form below

This Year’s Membership runs from 1^st January to 31^st December.

The fees are as follows;

$25 Single Membership for one year.

Allows for one year subscription for the Herbal Thymes newsletter, the sale of 10 plants on the Plant Stall per meeting and the loan of ONE library book per month.

$35 Family Membership – two people at the same address, for one year.

Allows for one year subscription for the Herbal Thymes newsletter, the sale of 20 plants on the Plant Stall per meeting and the loan of TWO library books per month.

(Please circle) New Member / Renewal / Change of Address

NAME: (Dr/Miss/Mrs/Mr) .....................................................................................................................................

CURRENT ADDRESS:.........................................................................................................................................

POST CODE: ......................................................................................................................................................

Previous Address: ..............................................................................................................................................

Phone: ................................................................. Mobile:...................................................................................

E-mail: ................................................................................................................

Yes, I would like my copy of the Herbal Thymes Newsletter emailed to me (please circle) YES

PLEASE INDICATE THE BRANCH FOR MEMBERSHIP:

Parent Body Northern Districts Peel Districts

PO Box 427 PO Box 2506 PO Box 408

COMO 6952 WARWICK 6025 KWINANA 6966

Please bring completed form and payment to a meeting, or post to:

The Treasurer, The Herb Society of Western Australia (Inc), PO Box 427, Como 6952.

Office Use Only:

Badge / Label / Membership Book / Membership Card

Receipt No: ……………………………………… Date: ……………………………..