ANIMAL WELFARE LEAGUE OF QUEENSLAND INC APPEAL / MEMBERSHIP FORM

Your Contact Details:

Mr Miss Ms Mrs Dr Name ______________________________________________


Address _____________________________________________________________________


Post Code __________ Contact No/s: ___________________________ Date: _____________

Membership Type: Ordinary - $30 Single $50 Couple
Pensioner - $10 Single $15 Couple
Student - $10
Life Subscription (once only fee) - $300 Single $500 Couple
Corporate / Business (includes advertisement in newsletter) - $300

I would like to become a Member / Renew my AWL Membership:

I hereby apply for Membership Membership Renewal of the Animal Welfare League Queensland Inc for which I enclose $______

for ____________________________________ (membership type). I agree to abide by the rules of the Animal Welfare League of Queensland Inc.:

Signature: _______________________________________ Date: ____________________

Membership Renewals are due 30th June each year!

I would like to support the Animal Welfare League Appeal:

Please accept a donation of: $25 $50 $100 $200 Other ____________

Method of Payment: Cheque Money Order Bankcard Visa Mastercard

Card Number: __ __ __ __- __ __ __ __ - __ __ __ __ - __ __ __ __ ----- __ __ __

Note: Please include the last 3 digits on the back of your card or we cannot process

Signature: ______________________________________ Expiry Date: ____________________

Please include a stamped, self-addressed envelope to allay costs for sending of your receipt

Post form to:

The Animal Welfare League of Queensland Inc, PO Box 3253, Helensvale Town Centre Qld 4212