NQCC

Membership/Donations Form

Support NQCC's efforts to protect the environment

Name

Address

Phone contact

E-mail

Join Earth Links NQ (tax-deductible): I would like to give monthly

Or join as a member

I would like to give a donation of $

I would like information on how to include NQCC in my will

I would lke a receipt

Direct deposit payment

I have transferred membership payment to NQCC's bank account: North Queensland Conservation Council Inc. Commonwealth Bank, BSB 064817, Account no. 00908564. (please type MEM and your surname in your description line).

I have transferred a donation payment to NQCC's bank account: North Queensland Conservation Council Inc. Commonwealth Bank, BSB 064817, Account no. 10100081. (please type DON and your surname in your description line).

Credit cards, cash, cheques and money orders can only be processed by mail or in person.

You will need to print this form and send it with your details.

Cash/ cheque/ money order (made payable to NQCC)

Or please charge my credit card

Card number: _ _ _ _ _ _ _ _ _ _ _ _

Name on card: ___________________________

Expiry date: ____/____ Cardholder's signature:______________________________

For your security, credit card details should be handwritten on printed form only

Please mail this form to:

NQCC

PO Box 364

Townsville, Qld, 4810.

THANK YOU FOR YOUR SUPPORT

Your information has been sent to our database.

We will send you confirmation advice when your form has been processed

Hermit Crab, Great Barrier Reef