* 1. Today's Date:

Date:
/
/

* 2. Your Name

* 3. What family name would you like to appear on the membership card? (eg. Jones family)

* 4. Postal Address

* 5. Phone:

* 6. Email:

* 7. Names of children to sign up to Wildwatch - please write name and age
(name will appear on certificate)

* 8. If more than 5 children - please enter further details here:

* 9. You will receive the Introduction pack by mail. After that, how would you like to receive further newsletters / invitations?

* 10. Any other comments / questions?

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