AUSTRALIAN NETWORK for PLANT CONSERVATION INC
STOP DIRECT DEBIT FORM
This form can be used to stop the automatic direct debit to the account nominated.
In processing this application this form you agree to the terms and conditions that apply to direct debit
cancellation and understand that you will not receive the Australasian Plant Conservation Bulletin
without indicating your preference for payment.
STOP payment for direct debit
Total Amount: $
Please refer to the membership table on the following page and/or visit our website for more information.
Visa
MasterCard
Card Number
/
/
/
Expiry Date
/
3 digit code
Cardholder’s signature
Name on Card
Terms and Conditions – direct debit cancellation

If you have not indicated an alternative form of payment, the services to receive the Australasian Plant Conservation Bulletin will
be discontinued;

If you provide an alternative form of payment, the service will continue and you will receive the bulletin through the distribution, provided
you have made these changes prior to the extract;

If your payment is received after the distribution, you will receive the bulletin directly from the office of the Australian Network for Plant
Conservation Inc and therefore, your bulletin will be received after the distribution date.

On receipt of this form, our office will remove your credit card details from the eWAY platform and you will be notified in writing on
completion, to confirm the date this was removed.

Should you have any discrepancies after the process is complete please feel free to contact our office so we can raise your queries
directly with eWAY;

Alternatively, should we find we are unable to resolve your queries, we recommend you contact your financial institution to obtain the
details from the disputed transaction to lodge a claim on your behalf;

For more information please visit our website at
NEW payment details
Indicate how you would like to proceed with payment in replacement of direct debit.
Total Amount: $
Please refer to the membership table on the following page and/or visit our website for more information
Direct Credit:
BSB: 633000 Account #: 139397830 Bank: Bendigo Description: Your name
Account name: Australian Network for Plant Conservation
Invoice my organisation
address
Cheque/Money order
Visa
for businesses, government agencies etc give contact name, full mailing & email
made out to “Australian Network for Plant Conservation Inc”
MasterCard This payment is processed by the ANPC direct with Bendigo Bank.
Expiry Date
/
/
/
3 digit code
/
Name on Card
Cardholder’s signature
Please complete the membership table on the following page.
G PO Box 17 7 7 C an b e rra ACT 26 0 1 Aus tr al i a
A BN : 7 0 8 61 4 8 0 8 18
T ele p h on e: ( 02) 62 5 0 95 0 9; F ax : (0 2) 6 2 50 95 2 8; Em ai l : a npc @ a n pc . as n. au
W ebs ite : h tt p: // ww w. a npc . as n .a u
AUSTRALIAN NETWORK for PLANT CONSERVATION INC
MEMBERSHIP TABLE
MEMBERSHIP TYPE/SUBSCRIPTION
(please check the box where appropriate)
1 yr
(Incl. GST)
3 yrs
(Incl. GST)
Individual Member
$70
$175
Individual Concession (full time students, pensioners,
unemployed)
$40
$100
Community Group (Additional benefit: receive 2 copies
of quarterly bulletin)
$105
$265
Small Business (< 20 employees) (Additional benefit:
receive 2 copies of quarterly bulletin)
$105
$265
Corporate/Government Agency (Additional benefit:
Bulletin mailed to up to 7 addresses)
$580
$1450
Library Subscription (2 copies of quarterly bulletin)
$105
$265
Check box for APC bulletin e-version instead of posted
paper version
DONATION ($2 or more tax-deductible)
$
Ecological Management and Restoration *
$74.80
n/a
(approx. 30% discount; usual
subscription $106.70)
UPDATE MY DETAILS
Member details
Note: memberships are for a calendar year, 1 January to 31 December
Please complete the form then email, fax or post to the ANPC at the address above.
Title
First name
Surname
Occupation
Organisation
PO Box/Street
Suburb/Town
Phone W
Stat
e
Postcode
Phone H
Mobile
Country
Fax
Email
Office Use Only: Access D/b updated
RN
Acknowledgement returned to customer
Date
/
/
Officer
Date
/
/
Officer
G PO Box 17 7 7 C an b e rra ACT 26 0 1 Aus tr al i a
A BN : 7 0 8 61 4 8 0 8 18
T ele p h on e: ( 02) 62 5 0 95 0 9; F ax : (0 2) 6 2 50 95 2 8; Em ai l : a npc @ a n pc . as n. au
W ebs ite : h tt p: // ww w. a npc . as n .a u
M’ship ID: