Application Form for Membership of Bywong Community


Name …………………………………………………………………………………………………………………….

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

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

Telephone:  ..................................(Home)   ...........................................(Work)

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

I would like to see Bywong Community involved in:

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

……………………………………………………………………………………………………………………………

I am willing to help in the following ways: (please tick)

Distribute leaflets
Lead bushwalks
Help at events
Other:  ...........................................................................................................

Please give this form, with your membership fee of $10, to a member of the Bywong Community Executive, or mail it to:
Secretary, Bywong Community
Po Box 486, Dickson, ACT   2602

Signature:  ................................................................

Date:   ........................................................................

For enquiries, please phone:
Nora Stewart
(02) 6230 3305