Yes! I want to become a member of NPA. I agree to abide by the objects of NPA as seen on the NPA website www.npansw.org.au
Your details - please print clearly

Mr/Mrs/Ms/Miss Surname: ______________________ Given Name: _________________ Date of Birth: ___________
Mr/Mrs/Ms/Miss Surname: ______________________ Given Name: _________________ Date of Birth: ___________
Address ____________________________________________________________
____________________________________________________________ PostCode ______________
Home Phone ____________________________________ Work Phone ________________________
Fax Number ____________________________________ Email _____________________________

Choose your Membership Type

.... NPA PARTNER - I wish to be an NPA Partner and make a monthly tax-deductible donation by direct debit or by credit card for the following amount. Please indicate the amount of your monthly donation:
.... $10 .... $20 .... $30 .... $50 other $______(minimum $10)
Donations will be debited the last week of each month. We will send you a receipt at the end of each financial year for the amount of your donations. At all times you remain in control and you can stop or change your donations any time you wish. NPA's membership in the Confederation of Bushwalkers Insurance Scheme covers you for personal injury on all NPA walks.

OR .... NPA MEMBER - I can't make a regular donation right now, but I would like to be an NPA Member in one of the following categories: Adult $55 Household $65 School/Library $65 Corporate $250 (incl GST) Concession $30 (all single payment, yearly) Click here to join

.... Payment Choice 1: Direct Debit

Name of Financial Institution where your account is held: ______________________________________________
Branch Address: ________________________________ Suburb/State:_____________ Postcode:__________
Account Holder(s) Name_______________________ Bank/Branch (BSB#)______ Account Number______________
Please complete this request to your financial institution and return to NPA for processing:
Dear Sir/Madam, I/We (names in full as on your account) ______________________________ request you, until further notice in writing, to debit my/our account described in the schedules above any amounts which National Parks Association of NSW (ID 069770) may debit or charge me/us through the Direct Debit System. I/We understand and acknowledge that:
1.The Financial Institution may in its absolute discretion determine the order of priority of payment by it or any moneys pursuant to this request or any authority mandate.
2.The Financial Institution may in its absolute discretion at any time by notice in writing to me/us terminate this request as to future debits.
3.The user may by prior arrangement advise me/us to vary the amount or frequency of future debits.
4.The user may charge me/us a $20 fee should insufficient funds be available in the above account.

Signature _____________________________ Date ____________ Signature ____________________________ Date ____________

.... Payment Choice 2: Credit Card

Please charge my credit card for the amount $___________ each month until further notice.
.... Bankcard .... MasterCard .... Visa Card No.-- ___________/___________/___________/___________
Cardholder's Name: ____________________________________________ ____________________________________________

Cardholder Signature: ___________________________________________ Expiry Date ____________

Thank you for joining NPA. Your New Members Kit will arrive in the mail shortly.
Please post this form to National Parks Association of NSW, PO Box A96, Sydney South 1235, or fax to us at (02) 9290 2525
Phone (02) 9299 0000 to join over the phone, or join via our website www.npansw.org.au


| Email to NPA. | Home | Copyright National Parks Association of NSW Inc. Last revised: 24 March 2004.