Wildwatch Family Registration

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* 1. Today's Date:

Date:

Date

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* 2. Your Name

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

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* 4. Postal Address

Address

Suburb

State

Postcode

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* 5. Phone:

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* 6. Email:

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

Child 1:

Child 2:

Child 3:

Child 4:

Child 5:

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

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

By mail (currently free - however, may be a small charge in future years)

By email

Comment:

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* 10. Any other comments / questions?