The Rosedale Association Inc.

Membership Application, Renewal and Payment Form

Payment by Cheque or Cash
Use this form to:
apply for new membership
renew your membership
make a Landcare fund donation or
advise a change to your membership details.
The annual membership subscription is $10 per voting member and subscriptions become due on 1st January each
year.
Please complete the details, print this form and send it with your cheque to:
The Treasurer
The Rosedale Association Inc.
PO Box 2125
Malua Bay, NSW, 2536.
If you wish to pay by Internet bank transfer or over the counter and are already a member of the Rosedale
Association please do not use this form. Instead use the following link www.rosedale.org.au/membership.html
Application Type (please tick one)
Membership
Renewal/Landcare donation

Change of Membership
Details

New Membership
Application

Name(s) of Voting Members

Email address

Name & Address (for Mailing)

Rosedale Address

Telephone Contacts

Rosedale Phone Contact Number

1.
2.
3.
4.

Home2222222222222222.
Rosedale 22222222222222.
Mobile2222222222222222
Payments
Membership subscription for _______ voting member(s) for the year(s):_______
(number)
(year(s)
Rosedale Landcare fund donation (optional)

$_______
$_______

Total: $_______
Weed notices (Please tick one)
Would you like advice on noxious weeds on your property?
Yes No
May we give your contact details to Rosedale Landcare if needed?
Yes No
Privacy: When collecting, using or disclosing personal information, the Rosedale Association has a policy of voluntary
compliance with the Australian Privacy Principles under the Privacy Act 1988 (Cth).
Office use only: Receipt No: ____________
Database updated (date): ________

Date:________ Transaction No: ________

Status: _________