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 _________
|