BirdLife Northern NSW
2016 Autumn Campout
Harrington, NSW
18-21 March
Registration form
CAMPOUT REGISTRATION
NAME
BIRDLIFE MEMBER?
1
YES 
NO 
3
YES 
NO 
2
YES 
Address:
Phone:
Mobile:
NUMBER
NO 
Postcode:
Email:
Register NOW - Registration closes 26 February 2016
NUMBER
BirdLife Australia member @ $27.50 per person
Non-Member @ $33.00 per person
Campout Dinner at the Club Harrington (Bowling Club) @ $35 per person for a two
course meal
[Please Indicate if you require a vegetarian meal, or dietary requirements ]
Yes 
MEMBERSHIP
No 
TOTAL
$
$
PAYMENT OPTIONS
1.
Cheque or Money Order:
Please return this form with your payment (made payable to BirdLife Northern NSW) to
Treasurer Laurie Piper: 166 Lyons Road, Sawtell, NSW 2452
2.
Direct Bank Transfer:
Account Name: BirdLife Northern NSW Community Fee Saver
BSB 082-407
Account #: 12-526-9855
N.B. If paying by direct transfer please send an email to Laurie Piper [email protected]
stating the date and amount of the transfer, and the names of all registrants included in that
payment.
Please also forward a copy of this form, either by email, or by post to Laurie Piper, details as
above.
Signed _________________________________________________
If you have a name tag holder, please bring it with you.
ACCOMMODATION
Accommodation is to be booked and paid for by participants.
The campout will be based at BIG4 Harrington Holiday Park, Harrington.
Bookings should be made directly with the BIG4 Holiday Park by phoning 1800 175 789 (not online) and mentioning ‘BirdLife
Camp’. Alternative accommodation options are also available within Harrington.
Please indicate below where you will be staying.

BIG4 Harrington Holiday Park

Elsewhere _____________________________(please indicate):
For any queries about the BirdLife Campout or if you require additional information please contact:
Ashley Carlson on (02) 6557 5393 (AH) or [email protected]
2
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