Harden Murrumburrah Landcare Group

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Membership Application

Online Membership Application Form

Help and suggestions for completing the form can be found at the bottom of this page.

required field
  email address: 
required field
tel:  mob:    re-enter email: 
required field
Address1:    Address2: 
Address3:    Postcode:        
subscription: $5-50   [on receipt of your application we will email payment instructions to you]


Areas of specific interest to me include: 

Once you have filled in the form, complete the security check below (not case-senstive) and click the "Submit" button. ; your application will be sent to the HMLG Coordinator.

Security check

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Type the above characters in the box below

Additional Information

Field Instructions
Name your name, as you prefer to be addressed
email preferred email address for correspondence from HMLG
tel telephone number
mob mobile phone number
Address 1,2, 3 your postal address
Areas of specific interest Enter as many or as few topics as you wish.
Security code verification Enter the characters displayed into the box below to prove that you're not an internet "bot".
If you can't read the characters clearly, click the refresh button to show a different set of characters.
Note that the characters are not case-sensitive.
Submit On clicking "Submit" your application will be sent to the HMLG Coordinator
Reset Clears all data from the form.


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