COG Membership Application Form

COG Membership Application / Renewal
New members - please provide all information including at least one phone number.

Renewals - no need to provide address or phone numbers unless they have changed. Remember to tick the boxes in Section 3 if you wish to continue to receive printed copies of publications.

Payment - pay by Bank Transfer (EFT) using the account information given below.
1. Your details
Name *

First Name Last Name
Title
Dr, etc
Name of Institution (organisations only)
Address
Street Address
Street Address Line 2
Town / Suburb
State
Postcode
Country
E-mail *
Phone
Home
Work
Mobile
2. Membership and payment
Membership Type *

Individual - $40 Institution - $40 Family - $45 Student - $20
Joining or renewing? *

New member Renewal
Names of Family Members covered by this membership *
Donation
Donation to Canberra Birds Conservation Fund
Total to pay .... $
Bank Transfer (EFT) - Transfer funds to:
Canberra Ornithologists Group Inc St George Bank Acc number 050111462 BSB 112-908
Note/comments
3. Preferences
Please indicate below if you would like to receive either or both of the following COG publications in printed form, mailed out to you. Otherwise you will be notified by email when new issues are available for you to view or download.
Receive Gang-gang newsletter by post Receive Canberra Bird Notes by post
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COG Membership Application / Renewal