Bicentennial National Trail Membership Application Form
ABN 83 010 860 143

Membership period July 1 to June 30. 


Complete the form below and post or email with your payment to:

The Bicentennial National Trail Ltd

PO Box 1196 NERANG QLD 4211

email: order@nationaltrail.com.au

Phone 1 300 138 724 (within Australia)


Full name:___________________________________________________________________________

Postal Address:____________________________________________________________________

________________________________________State:____________________ Postcode___________

Phone (Business): __________________ Phone (Home): ________________Mobile: ________________

email Address: _____________________________

MEMBERSHIP FEE:
$35 for individuals: [_]    Three years $90: [_]  $55 for Family or Club: [_]    Three years: $150 [_] 

If family membership then only one vote allowed and nominated person to be advised.
If club membership then two votes allowed and nominated persons to be advised.

DONATION
[_] $20    [_]  $50    [_] $100    [_] $500    [_]  Other __________

Family memberships; one vote allowed the nominated person is?________________________________________

Club or Business memberships; two votes allowed and nominated persons are?_____________________________

_______________________________________________________________________________________________

PAYMENT BY EFT (preferred)

Bank of Queensland BSB: 12 4001 Account number: 10 285 229
Reference: Please enter your name/new member/renewal/order

Please make sure to include the reference above.

Please send email to order@nationaltrail.com.au with receipt of payment details to confirm payment.

PAYMENT BY CREDIT CARD (5% processing fee):

Please charge $........... to my [_] Mastercard,    [_] Visa

Cardholder Name: _______________________________________________________

Expiry date (day/month/year): [__][__] [__][__] [__][__]

My card number is:

[__][__][__][__] [__][__][__][__] [__][__][__][__] [__][__][__][__]

Cardholder's Signature: _________________________________________________

PAYMENT BY CHEQUE OR MONEY ORDER:
Cheque [_]   Money order [_] Please make payable to The Bicentennial National Trail Ltd (not BNT)

I am primarily a [_]walker, [_]horserider, [_]cyclist, [_]donkey/camel packer, other ...............................

How did you find out about the BNT?
Website[_] Word of mouth[_] Magazine or newspaper article[_] Other[_]....................................

All annual membership renewals are due 30th June.  New memberships paid between
January and June provides continuous membership until June of the following year.