SGSANZ Home > Membership > Printable Form
| Name: _______________________________________________________ | ||
| Address:
______________________________________________________ ______________________________________________________________ ______________________________________________________________ |
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| State: ___________________________________ Postcode: ____________ | ||
| Country: __________________________ | ||
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Telephone: ___ ( ___ ) _______________ Fax: ___ ( ___ ) ______________ |
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| E-Mail: ______________________________________________________ | ||
| Position: _____________________________________________________ | ||
| I wish to apply for membership of the Scientific
Glassblowers Society of Australia and New Zealand. I agree to abide by
the constitution and require my correspondence to be mailed to the above
address. A full / student membership fee of ___________AUD $ is attached. |
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| Full: 1yr $25.00 | 2yrs $45.00 | |
| Student: 1yr $10.00 | 2yrs $18.00 | |
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| Signed:_______________________ Date:_________________________ | ||