MEMBERSHIP FORM
              BRISBANE REGION ENVIRONMENT COUNCIL


Yes, I would like to become involved with BREC by becoming
a member of The Web Incorporated, as

[ ] Individual Member                      $20 (*)

[ ] Small Group (under 50 members)         $20 (*)

[ ] Large Group (over 50 members)          $50

[ ] Business Member                        $50

Name of group or business:_________________________________


Surname:_______________________________


First Name:____________________________


Address: __________________________________________________


         __________________________________________________


         ___________________________ Postcode: ____________


Telephone: ____________________________


My main areas of interest are:

___________________________________________________________


___________________________________________________________


___________________________________________________________


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(*) Concessional fees of $10 are available.


Cheques should be made payable to "The Web Incorporated".

Please return to:

         Secretary The Web Incorporated
         Brisbane Region Environment Council
         PO Box 479       
         Morningside
         QLD 4170