30 Hardgrave Road, West End (Brisbane) QLD 4101
Phone: (07) 3211 4466 Fax: (07) 3211 4655
Email: edoqld@edo.org.au
ABN 14 911 812 589
ANNUAL MEMBERSHIP FORM
Please note: Membership is renewable each financial year
TYPE OF MEMBERSHIP: (please select one)
 Organisation/Group
Name of Organisation:
Name of Contact Person:
 Individual
Name of Individual:
Occupation:
Area of expertise/ interest
CONTACT DETAILS:
Address
Suburb/Town
Postcode
Email
Home Phone
Work Phone
Mobile
Members receive regular Bulletins and Alerts from EDO Qld.
How would you prefer to receive these?
 EMAIL
 POST
 I/We hereby apply for membership of the Environmental Defenders Office (Qld) Inc
 I am already a member
Signed:
Date:
MEMBERSHIP FEES (please tick whichever is applicable)
 Organisation $60.00
 Individual $25
 Student/pensioner $15.00
N.B.all fees include GST. A tax receipt will be sent after processing.
METHOD OF PAYMENT
 Cheque/Money Order
Card Number
 Mastercard
 Visa
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Name On Card
 Cash (in person only)
Expiry Date
......./.......
Signature
 I/We authorise EDO Qld to automatically renew my/our membership each year
PLEASE MAKE A TAX DEDUCTIBLE DONATION
Go to our secure online facility www.givenow.com.au/edo, or complete the section below:

I/We would like to make a one-off donation of $…………………

I/We would like to become a FRIEND OF THE EDO by contributing a monthly amount of:
 $25
 $50
 $75
 $100
 Other $……… ($15 minimum)
(NB: To choose this option, you must provide a credit card number above)
VOLUNTEERING AT EDO QLD
 Please send me information about volunteering for EDO Qld
 Please send me information about joining EDO Qld’s list of experts & legal professionals for client
referrals