Urban Bushland Council WA (Inc)

ABN 50 595 076 388

TAX INVOICE

Community Group membership

Group Name:

Representative 1:

Address:

Suburb:

Post Code:

Phone:

(h)

(w)

Email 1:

Representative 2:

Email 2:

Our group would also like to receive (please tick if required):

Council Minutes:

by post to above address

by email to above address

Individual Supporter membership:

Name:

Address:

Suburb:

Post Code:

Phone:

(h)

(w)

Email:

I would also like to receive (please tick if required):

Council Minutes:

by post to above address

by email to above address

Membership Fee enclosed	$
Donation:	$
Total	$

Please send cheques to the Treasurer, payable to:

Urban Bushland Council WA Inc

PO Box 326

West Perth WA 6872