Sub Form

SUBS 2010/11

South Coast Environment Society

Individual $15.00 $............ Family $20.00 $............ Or Group/Business $30.00 $............

subs also due for following groups:

Estuary Care $ 5.00 $............

Organic Group $5.00 $............ Seed Savers Annual Donation $..........

I/We wish to make a further donation to Support: (Which group/project/The Centre) $..............

TOTAL ENCLOSED: $

Date Paid:

Paid by cheque/internet banking

SCES

06 0954 0032740 01

(Please put your name in the reference)

Name:

Address:

Phone:

Email:

Please post | email my newsletter out

(Circle which you prefer)

Return to:

South Coast Environment Centre 154 Palmerston St Riverton 9822