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The Entomological Society of New South Wales

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Membership Form

I / we wish to apply for membership of The Entomological Society of New South Wales Inc.

My cheque for $……….. for membership is enclosed.

Membership Category (please tick)

          Ordinary   ...................           Associate  ................

          Student    ....................           Corporate ...............

Name: ……………………………………….…............................................................

Signature: ……………………………………..............................Date.........................

Address: …………………………………….…............................................................

………………………………………………….............................................................

Phone.......................................................................Fax..................................................

E-mail: ………………………………………….............................................................

Main Interest..................................................................................................................

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