RECLAIM CABOOLTURE SHIRE Inc.

                  OUR SHIRE - OUR COUNCIL - OUR CHOICE      

                    MEMBERSHIP APPLICATION/DONATION

    NAME (please print)..........................................................

    I AGREE WITH THE AIMS OF THE ASSOCIATION

    Enclosed is $10..Membership Fee         

    Enclosed is $....for Donation    TOTAL $................

        I AM ABLE TO CONTRIBUTE TO THE WORK OF THE ASSOCIATION

        Frequently and Regularly/occasionally/some weekends only/rarely (Circle one)

  I HAVE EXPERIENCE, KNOWLEDGE, SKILLS OR QUALIFICATIONS THAT COULD HELP THIS

CAMPAIGN (Please list)........................................................................................

CONTACT DETAILS:

Street Address ..................................................

Suburb.................................Postcode.............. 

Email address.......................................................

Telepone (Home)...........................(Work)..........................................

SIGNATURE...............................................

Please forward to friends who could be interested in this project.

PAYMENT: May be made by cheque or money order to: 

R.C.S. 13 Orchid St Bellara Q 4507

Print and post this form with $10 payment to become a member and receive  newsletters.  Online direct deposits as below:


 ONLINE PAYMENTS:

Suncorp Bank - Account Name: Reclaim Caboolture Shire Inc

 Direct Deposit – BSB Number 484-799

Account Number 451605585

PLEASE –          INSERT YOUR NAME IN THE REFERENCE NUMBER SPACE

                    OTHERWISE WE DON’T KNOW WHO YOU ARE. Thanks RCS Committee