Canberra Ornithologists Group Inc
Membership Renewal/Application
2008-2009

Please print this form, complete it and post it with your payment to:

The Secretary,
Canberra Ornithologists Group Inc.
PO Box 301
CIVIC SQUARE ACT 2608

Title and Name: __________________________________________________

Address: ________________________________________________________

________________________________________________________________

______________________________________________ Postcode: _________

Telephone (home): __________ (work): __________ (mobile): _____________

Email: ________________________________________________

I/We enclose $________ as Renewal/New Membership being:

Individual - $35	Optional donation to Canberra Birds Conservation Fund $ _______
Institution - $35	(office use only) Subtotal $ _______
* Family - $35	GST $ _______
Student (18yrs or under) - new $17.50	Total $ _______
(all amounts GST inclusive)

*Family memberships: please list the names of all members covered by family membership:

______________________________________________________________________________

If you would prefer Gang-gang in Electronic form (PDF Format - requires Adobe Acrobat Reader)
to be sent to the above email address in lieu of printed copy please tick here..............

Are you interested in any of the following COG activities? (please tick)

Atlassing/Bird Surveys	Data entry
Administration/Office	Leading outings
Publicity/Exhibition stalls	Youth education
Publications	Conservation issues

July 2002