Application for Membership

ABN 96 098 118 300 - Tax Invoice
ACN 098 118 300

Please print this form, complete the relevant information and mail with payment to:

The Treasurer
Rare Breeds Trust of Australia
PO Box 220
Heathcote Vic 3523

1. Details of Applicant

Name of Applicant................................................................................................................................................... of

Address of Applicant................................................................................................................................................

2. Contact Details

Phone No.:............................................... Fax No.:...............................................

Alternate Phone No.:................................ Mobile No.:..........................................

Email:....................................................................................................................

("Applicant) hereby applies to become a member of Rare Breeds of Australia Ltd ("Company")

3. The Applicant

(a) agrees to become a member of the Company;
(b) authorises the directors of the Company to enter the Applicants name on the register of members;
(c) agrees to be bound by the Constitution of the Company; and
(d) agrees to pay such fees as are authorised by the board from time to time.

4. Category of Membership

The Applicant must tick one of the following categories of membership. This is an indication of preference only, and this nomination is not binding on the board.

Tick	Category	Membership Fee (A$)	Votes	Additional Information required by the Company
	Individual	35.00	1 Vote, 1 Newsletter	Nil
	Associate	20.00	1 Newsletter	Nil
	Pensioner	20.00	1 Vote, 1 Newsletter	Pension Number................................
	Family	55.00	2 Votes, 1 Newsltter	There are [ ] member on this application The Names of these family members are: ............................................ name of member ............................................ name of member Voting rights for this family will be exercised by................................ or by proxy as indicated by those persons.
	Pensioner Family	30.00	2 Votes, 1 Newsleter	Pension Number................................ Name of Member Pension Number................................ Name of Member
	Junior	15.00	1 Newsletter	The Applicants date of births is: ..../..../.... Signature of the parent or guardian of the Applicant: .............................................. signature
	Association	35.00	1 Newsletter	The Applicants ACN or ABN or Inc. Registration Numbers is: ..............................................................
	Donation		Please find enclosed my donation to support the work of the Trust (or see donations page)

5. All Applicants for Junior membership must include the signature of their parent or guardian, consenting to this Application

6. Membership Fee
Attached to this Application is a cheque for the amount of [................] made payable to the Company in payment of the Membership Fee for the applicable category of membership.

SIGNATURE/S OR SEAL........................................................................ DATE....................................

A receipt will only be issued if requested and a stamped self addressed envelope enclosed.

Do you have any skills, which you would be prepared to make available to the Company. Eg., Accounting, Legal, Verterinary to name a few.

If so would you please state them:..............................................................................

Last updated 8 February 2008