New Membership Form

A. Please provide the following contact information:

Name
Company
Address
Address
City
State/Province
Post Code
Country
Phone
Fax
Mobile

E-mail

E-mail2

Would you like to be on our "email updates" list? Yes No

B. Which branch would you like to belong to: Please select only one.

Geelong Hamilton Tasmania
Streatham Gippsland

C. Briefly about yourself/business:

Livestock:

Sheep Cattle Other ____________________

Crops:

Barley Canola Oats
Wheat Legumes Other

General location of your property(s)

Total area of your property (hectares)

Total cropped area approx. (hectares)
Dryland Irrigation

Due to new Privacy Legislation, I need to seek your approval for our Principal Sponsor’s to be able to send you information or contact you from time to time.

I do not want Southern Farming Systems Ltd to give my contact details to our Principal Sponsors only.

Membership costs as of 1st October 2008

(please tick which option you will be taking and how payment will be made):

Grower Membership
 Core Membership for Primary Producers. $200
1 year		 $540
3 years
Commercial Membership
For companies and organisations involved
with marketing commercial good and services.		 $1000
1 year		 $2700
3 years
Associate Membership
 For non-profits, universites, public sector
employees and non commercial research
organisations.		 $350
1 year		 $950
3 years
Student Membership
 Covers any student undertaking either
undergraduate or postgraduate studies.		 $50
1 year only

I will be posting a cheque or money order to:

Southern Farming Systems
PO Box 8047
Newtown VIC 3220

I have paid by direct deposit into the SFS bank account:

Southern Farming Systems Ltd
BSB 083585 (National Australia Bank, Colac Branch)
ACC 48502 8326

please let us know the reference that you left so we can match your payment with the membership database.

D. Please print this form and post or fax to

Southern Farming Systems
PO Box 8047
Newtown VIC 3220

Fax: 03 5229 4426
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