APPLICATION FOR MEMBERSHIP
I / We wish to become member/s of FRIENDS OF HERRING ISLAND INC. (A0028229X)(ABN 71 627 163 439)

Full Membership
[ ]  Entrance Fee - 	$10.00
[ ]  Annual Fee   - 	$ 2.00         
          or                                                    
Associate membership 
[ ]  Annual Fee  	$ 3.00
                             
TITLE      :  __________________                         

GIVEN  NAME      :  __________________                         

FAMILY NAME      :  __________________                         

Address          :  _________________________                  

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Telephone  :(H)     ______________                             

Telephone  :(W)     ______________                             

Email      :        _________________________

Occupation       :  _________________________                  

Special Interests: 	

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Please print and complete this form, then send it to:

     THE TREASURER,
     FRIENDS OF HERRING ISLAND INC.
     10 GRACE ST,
     MONT ALBERT VIC 3127