The Australian Dingo Conservation Association
Incorporated. (Inc 9882972)

ABN: 117754793

PO Box 444 Erindale Centre, ACT 2903
Phone: (02)62355445
E-mail: adca@yless4u.com.au

Membership Application

Name: ......................................................................................

Postal Address:...........................................................................

...........................................................................Postcode.........

Telephone:....................... E-mail:.............................................

Membership Subscription details.
Joining Fee: $15.00

[ ]   Family/ Full $40
[ ]   Pension/Student (cardholder) $25
[ ]   Associate $15
(please tick the type of membership you want)

Cheques or money orders are accepted.

Annual Subscription for Newsletter: $10 per year [ ]

I/we agree to be bound by the Constitution, Rules, Code of Ethics and Code of Practice of the Australian Dingo Conservation Association Incorporated.

Signature................................ Date............

Mail to the Secretary at the above address.