APPLICATION FOR MEMBERSHIP OR MEMBERSHIP RENEWAL

Membership is open to Villages as a whole OR to individual occupants:

Villages:      $2 – per OCCUPIED residence per year.

Individual:   $10 – per person per year.

Payments:    due from the 1^st January each year.

Inquiries:  Telephone:  9271-2733.

 DETAILS FOR VILLAGE OR INDIVIDUAL MEMBERSHIP

NAME  (Village or Individual)…………………………………………………………

ADDRESS………………………………………………………………………………

…………………………………………………………………………………………..

TELEPHONE…………………………………………………………………………..

NUMBER OF OCCUPIED RESIDENCES IN VILLAGE  @ 1^ST JANUARY………

NAME OF CONTACT RESIDENT IN VILLAGE……………………………………

CONTACT TELEPHONE NUMBER…………………………………………………

CONTACT E-MAIL ADDRESS……………………………………………………….

DATE OF APPLICATION……………………………………………………………..

SIGNATURE OF APPLICANT…………………………………………………………

Please forward, together with payment to:

The President,

WARCRA,

.C/- COTAWA, PO Box 866, West Perth, WA  6872