SPECIAL  INTEREST  GROUPS

   APPLICATION  FOR  MEMBERSHIP

Name:

Address:

Phone: (H):

(W):

Email:

Fax:

Membership No.

I wish to join the following Special Interest Group (s):-

 

 

 

 

Enclosed is $15.00 (incl GST) membership fee for each Group.

If you are posting this application form, please include a stamped self addressed envelope.

Come along to the next meeting of the Group (s) and make yourself known to the person chairing the meeting.

Applicant's  Signature:

Date: