Southern Sandy Straits Marine Environment Group Inc (SSSMeg)

Membership Application Form

1/We wish to support the objectives of SSSMeg by becoming a member

Your name Name :

Your email details Email address :

Address Street or PO Box :

Town or City City :

Postcode Postcode :

State State :

Annual Membership Membership type :

Individual memberships are $2.00 (or $7 with a certificate), Family memberships are $10.00

Family memberships include a laminated certificate of membership featuring Harmony and Mystique - two of the local Indo Pacific humpback dolphins. Enter the names to go on the certificate in the special instructions area of the form.

Payment Method Payment type :

Cheque payments should be made out to Southern Sandy Straits Marine Environment Group Inc and addressed to:

The Secretary
PO Box 346
Rainbow Beach, QLD, 4581

Applications for EFT payment will be advised of banking details by return email.

Special Instructions

Enter details including names to go on certificates

To submit this form, please enter the characters you see above in the image. If you cannot read the image, click for a new one.