Miranda Naturalists' Trust Membership Request
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    • Individual Member
    		 $35.00
    • Family
    		 $40.00
    • Overseas Member
    		 $40.00
    • Life member under 50
    		 $1050.00
    • Member 50 and over
    		 $525.00
    Rates inclusive of GST
    Financial Year 1 January - 31 December

    Please print the following form and post to:

    Miranda Naturalists' Trust
    RD 3, Pokeno.
    New Zealand

    Yes, I wish to become a member

    Please complete the following details :

    Your Name:______________________________________________________

    Your Address:____________________________________________________

    ________________________________________________________________

    _________________________________________________________________

    Country:_________________________________________________
     
    Email Address:__________________________@___________________________________

    Phone Contact:_____________________________________________

    Type of Subscription required: ( Circle one) Individual / Family / Overseas / Life (over 50) / Life (under50)

    Payment Options:

    Cheque enclosed $ ___________________( If you require a receipt please tick the box: )

    Visa             
    Mastercard           

    Number:____________________________________________________

    Expiry Date:_________/________/___________________

    Card Holder Name:________________________________

    Signature:______________________________