ANTaR (WA) Membership Application Form

Membership is for a year. Your membership fee covers mailouts and provides funds for running the organisation (ANTaR (WA) has no paid staff and funds are primarily used to produce flyers and posters...etc).

Please print this form and return it to:

ANTaR (WA)
c/o 99 Hay Street
Subiaco WA 6008

Name:
 		  
Occupation / Organisation
 		  
Postal Address Street:

Town:

PostCode:
Phone: Home:

Work:
Fax:
 		  
Email:
 		  
Membership:
  • Personal $10
  • Unwaged $5
  • Organisational $25+
  
Donation:
 		 $
I have read and unequivocally support the Australian Citizen's Statement on Native Title.

Signed: