THE LINNEAN SOCIETY OF NEW SOUTH WALES

APPLICATION FOR MEMBERSHIP

-Please print, fill out and return this form to the Secretary at the address below-


Title (Prof, Dr, Mr, Ms etc.)......................

Name in full ....................................................................................................................................

Residential Address..........................................................................................................................

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Postal Address...................................................................................................................................

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Telephone (business hours) (..............)..............................................................................................
 

E-mail...............................................................................................
 

Category of Membership:
Please tick:
 I enclose:
. Full Member $40 
. Student Member $20 and proof of student status. I am not in full-time employment.
. Retired Member $20 and I am 60 years of age or over
. Associate Member $10

 
 
 

Signature of Applicant.............................................................Date................................20..........

 

 

Proposed by*...................................................................................................................................

Seconded by*...................................................................................................................................

*Not required for Associate Membership. Proposer and seconder must be financial members of the Linnean Society. If your circumstances (such as where you live) make it difficult to find a proposer and seconder, send in an application nevertheless and we will arrange nomination for you.

Please indicate your particular field(s) of interest briefly here

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Send completed application with payment to The Secretary, Linnean Society of NSW, PO Box 82, Kingsford NSW 2032.

-OFFICE USE ONLY-



Certificate Received........................................20......

Candidate Elected...........................................20......