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Membership Application and/or Donation form - please print

[Membership fee is $15.00 (individuals) or $15 (families)], Life membership is $100. payable to:

The Treasurer
Thames Coast Protection Society
PO Box 396
Thames

Name __________________________
Address ________________________
________________________________
Phone __________________________
Email __________________________

Thames Coast Protection Society is registered with the Charities Commission Reg No. CC20689. All donations are tax deductable. (please advise if you want a receipt).

Either Direct credit our Bank account:Thames Coast Preservation and Protection Society (Inc)
KiwiBank Acc no: 38 9005-0911920-00

(please advise us of your donation with contact details above) -
treasurer@pohutukawa.org.nz

or print and post this form:

I enclose a cheque for $.........., of which $.......... is a donation. I would like this donation to be used for:

I am interested in helping with the;

Anti-mining project YES / NO

other TCPS projects. YES / NO

What conservation work would you like to be happen/be involved with locally?