Text Box: BearsCanberra Inc Membership Application /Renewal BearsCanberra GPO Box 1694 Canberra ACT 2601 www.bearscanberra.org.au secretary@bearscanberra.org.au Membership Application NEW / RENEWAL Name: _________________________________________ D/O/B: _______________ Residential Address: ______________________________________________________ Town/Suburb: _________________________State: _________ Postcode: ___________ Postal Address: ______________________________________________________ Town/Suburb: _____________________State: _________ Postcode: ___________ E-mail: ____________________________________________________________ Home Phone: ______________________ Mobile: ___________________________ EFT payment is available — email form with EFT payment request to the Secretary and details will be forwarded to you. Please complete this application and include your cheque or money order for $20 per person or give to committee member if attending a function You can send the completed form and payment to The Treasurer BearsCanberra Inc, GPO Box 1694, CANBERRA ACT 2601 A BearsCanberra membership card and receipt will be posted to you on finalisation of membership. For more information please visit our website at www.bearscanberra.org.au or, email: secretary@bearscanberra.org.au