PSW Membership Form 2018

Membership type (please select) *

- Family membership is available to 1-2 adults & children under the age of 18 all living at the same address List all names on family membership.SingleFamily

First Name - Adult 1 *

Family Name adult 1 *

First Name - Adult 2

Family Name - Adult 2

Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Email *Please enter a valid email address

Email Please enter a valid email address

Phone

Emergency Contact for Adult 1

Emergency Contact for Adult 2

First Name *

First Name

Relation *

Relation

Mobile/Phone Number *

Mobile/Phone Number

What is your Local Council

CumberlandBlacktownCastle HillPenrithHawkesburyParramattaOther

If you checked other, please advise which council

How did you hear about us?

InternetFriendSocial MediaMeetupWorkshopFlyerWebsiteOther

What would you like to gain from Permaculture Sydney West? Person 1

What would you like to gain from Permaculture Sydney West? Person 2

Tell us about your hobbies and things you like to do, favourite pastimes or any skills you may be willing to share. Person 1

Tell us about your hobbies and things you like to do, favourite pastimes or any skills you may be willing to share. Person 2

Have you done a Permaculture course?

YesNo

If Yes

IntroPDC

Who was your Teacher?

If 'No' Would you be interested?

YesNo

How to Join Permaculture Sydney West

PSW Membership Application

Verification

PSW Membership Application

Verification