Membership Form

FONB Membership
Name (please complete additional box for family memberships)
Name (please complete additional box for family memberships)
First
Last
Name
Name
First
Last
1. As a North Bruny ratepayer I/we provide the Kingborough Council Rates Notice Property Identification Number:
2. As a North Bruny Resident the address at:
Individual: $15 per annum Family: $25 per annum Centrelink Card Holders $5 discount Preferred Payment Method Direct Bank Deposit ensuring you include your full name as reference. Bank Details: BSB 067006 / Account Number 10011898