SGSANZ Home > Membership > Renewal Form
| Name: ________________________________________________________ | |
| Type of membership (tick one of the boxes): | |
| Full 1yr $25.00: | |
| Student 1yr $10.00: | |
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Full 2yrs $45.00: |
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| Student 2yrs $18.00: | |
| Update your contact details by entering the
required information: Address: _____________________________________________________ _____________________________________________________________ _____________________________________________________________ |
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| State: ___________________________________ Postcode: ____________ | |
| Country: ______________________________ | |
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| Telephone: ___ ( ___ ) _______________ Fax: ___ ( ___ ) ______________ | |
| E-Mail: _______________________________________________________ | |
| Position: ______________________________________________________ | |
| Please use above form to notify us of any change of address
or contact details and send to: Mr Dennis Clair, Treasurer SGSANZ Allirra Glassblowing Pty Ltd 41 Weston Street Naval Base Western Australia 6165 |
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| Signed:_______________________ Date:_________________________ |