AFMA
Australian
False Memory
Association
(Incorporated)

 

DONATIONS & MEMBERSHIP APPLICATION FORM
(In confidence)

 Please print clearly

Name: ...................................................................................................

Address: ...............................................................................................

..............................................................................................................

..............................................................................................................

..............................................................................................................

 

 Telephone:

[Home] .........................................

[Work] .........................................

Please circle:

Full membership for 12 months
(husband/wife permits 2 votes at meetings)
Individual membership for 12 months
Professional membership for 12 months
Seniors/Full Time Students membership for 12 months
I enclose/pledge additional donation of:
I do not wish to become a member at this time but I would like to subscribe to the AFMA newsletter:

 Annual subscription

 AU$20.00

 

 Student AU$15.00

 

 International AU$35.00

TOTAL

$ 90.00

$ 50.00
$100.00
$ 30.00
$.







.............

Donation:

I support the aims and objectives of the AFMA
and wish to donate the sum of :-

$ A _________

 

Mail membership form with your cheque to:

AFMA
PO Box 74
Campbelltown SA 5074

Ph: 1300 88 88 77