Great  Barrier  Island  Charitable  Trust

Membership Application

E-mail Address: *
Name *
Type of Membership *

Annual Student Membership - $15.00
 Annual Ordinary Membership - $25.00
 Annual Senior Membership - $20.00
 Family Membership - $35.00
 Corporate Membership - negotiable
 Life Membership - Senior - $200.00
 Life Membership - $250.00

For Family Membership
please list names of family members
Address *
Phone *
Cellphone
Fax
Association with Great Barrier Island * GBI Resident
 GBI Ratepayer
 GBI Resident & Ratepayer
 Visitor
Comments:
* Required    When your application form is received we will send bank account details for payment.  Thank you

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Copyright © 2005  [Great Barrier Island Charitable Trust]. All rights reserved.